Healthcare Provider Details

I. General information

NPI: 1578922985
Provider Name (Legal Business Name): BETHESDA FAMILY SERVICES FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 REITZ BLVD SUITE 6
LEWISBURG PA
17837-9220
US

IV. Provider business mailing address

260 REITZ BLVD SUITE 6
LEWISBURG PA
17837-9220
US

V. Phone/Fax

Practice location:
  • Phone: 570-523-0605
  • Fax:
Mailing address:
  • Phone: 570-523-0605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC007996
License Number StatePA

VIII. Authorized Official

Name: MRS. GINALYN ELIZABETH BAVERO
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC
Phone: 570-523-0605