Healthcare Provider Details

I. General information

NPI: 1477947620
Provider Name (Legal Business Name): SUSQUEHANNA VALLEY COMMUNITY MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

546 BROADWAY
HANOVER PA
17331-2007
US

IV. Provider business mailing address

546 BROADWAY
HANOVER PA
17331-2007
US

V. Phone/Fax

Practice location:
  • Phone: 717-739-6576
  • Fax: 717-630-9678
Mailing address:
  • Phone: 717-739-6576
  • Fax: 717-630-9678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC003017
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017668
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHARRON HILL
Title or Position: CEO
Credential:
Phone: 717-739-6576