Healthcare Provider Details

I. General information

NPI: 1265482863
Provider Name (Legal Business Name): FAMILY SERVICES OF NW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 PEACH ST
ERIE PA
16509-2482
US

IV. Provider business mailing address

5100 PEACH ST
ERIE PA
16509-2482
US

V. Phone/Fax

Practice location:
  • Phone: 814-866-4500
  • Fax: 814-864-2677
Mailing address:
  • Phone: 814-866-4500
  • Fax: 814-864-2677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN GRESH
Title or Position: CFO
Credential:
Phone: 814-866-4504