Healthcare Provider Details

I. General information

NPI: 1801029269
Provider Name (Legal Business Name): CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 SALE BARN RD
MIDDLEBURG PA
17842
US

IV. Provider business mailing address

PO BOX 219
DANVILLE PA
17821-0219
US

V. Phone/Fax

Practice location:
  • Phone: 570-565-7163
  • Fax:
Mailing address:
  • Phone: 570-275-5422
  • Fax: 570-275-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number327200
License Number StatePA

VIII. Authorized Official

Name: MR. RICHARD DELOS BEACH
Title or Position: ADMINISTRATOR
Credential: LCSW, BCD
Phone: 570-275-5422