Healthcare Provider Details

I. General information

NPI: 1639201023
Provider Name (Legal Business Name): GREENCASTLE FAMILY PRACTICE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 EASTERN AVE SUITE 115
GREENCASTLE PA
17225-1100
US

IV. Provider business mailing address

50 EASTERN AVE SUITE 135
GREENCASTLE PA
17225-1100
US

V. Phone/Fax

Practice location:
  • Phone: 717-597-0095
  • Fax: 717-597-3147
Mailing address:
  • Phone: 717-597-0095
  • Fax: 717-597-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS008907L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC000234
License Number StatePA

VIII. Authorized Official

Name: MRS. JENNIFFER L SHOWALTER
Title or Position: EXEC ASSISTANT
Credential:
Phone: 223-465-2025