Healthcare Provider Details

I. General information

NPI: 1902363179
Provider Name (Legal Business Name): NORTHEAST COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E BROAD ST
HAZLETON PA
18201-6835
US

IV. Provider business mailing address

750 E BROAD ST
HAZLETON PA
18201-6835
US

V. Phone/Fax

Practice location:
  • Phone: 570-455-6385
  • Fax:
Mailing address:
  • Phone: 570-455-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier18775250053
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: RICH ZABINSKI
Title or Position: MIS DIRECTOR
Credential:
Phone: 570-455-6385