Healthcare Provider Details

I. General information

NPI: 1669923264
Provider Name (Legal Business Name): NORTHEAST THERAPEUTIC WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 BIRNEY AVE
MOOSIC PA
18507-1301
US

IV. Provider business mailing address

1415 PENN AVE
SCRANTON PA
18509-2325
US

V. Phone/Fax

Practice location:
  • Phone: 570-815-3823
  • Fax:
Mailing address:
  • Phone: 570-815-3823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNNE OPSASNICK
Title or Position: OWNER
Credential: LCSW
Phone: 570-815-3823