Healthcare Provider Details

I. General information

NPI: 1639213473
Provider Name (Legal Business Name): WYOMING VALLEY CHILDRENS ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 WYOMING AVE
FORTY FORT PA
18704-4003
US

IV. Provider business mailing address

1133 WYOMING AVE
FORTY FORT PA
18704-4003
US

V. Phone/Fax

Practice location:
  • Phone: 570-714-1246
  • Fax: 570-714-1249
Mailing address:
  • Phone: 570-714-1246
  • Fax: 570-714-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: NINA ZANON
Title or Position: OFFICE MANAGER
Credential:
Phone: 570-714-1246