Healthcare Provider Details

I. General information

NPI: 1609099837
Provider Name (Legal Business Name): COLONIAL INTERMEDIATE UNIT 20
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 DANFORTH DR
EASTON PA
18045-7899
US

IV. Provider business mailing address

6 DANFORTH DR
EASTON PA
18045-7899
US

V. Phone/Fax

Practice location:
  • Phone: 610-252-5550
  • Fax: 610-515-6457
Mailing address:
  • Phone: 610-515-6439
  • Fax: 610-515-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number235100
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number235100
License Number StatePA

VIII. Authorized Official

Name: CHRISTOPHER S WOLFEL
Title or Position: EXECUTIVE DIRECTOR
Credential: D. ED
Phone: 610-252-5550