Healthcare Provider Details

I. General information

NPI: 1962756031
Provider Name (Legal Business Name): INSTITUTE FOR LEARNING & BEHAVIORAL SCIENCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 E CARACAS AVE STE 300
HERSHEY PA
17033-1184
US

IV. Provider business mailing address

1512 E CARACAS AVE STE 300
HERSHEY PA
17033-1184
US

V. Phone/Fax

Practice location:
  • Phone: 717-439-5908
  • Fax:
Mailing address:
  • Phone: 717-439-5908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00488600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CLINT C STANKIEWICZ
Title or Position: EXECUTIVE DIRECTOR/PRESIDENT
Credential: PSY.D.
Phone: 717-439-5908