Healthcare Provider Details

I. General information

NPI: 1891304721
Provider Name (Legal Business Name): HAMIDIAN TRAINING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2020
Last Update Date: 07/27/2020
Certification Date: 07/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 BIRNEY AVE STE 8
MOOSIC PA
18507-1330
US

IV. Provider business mailing address

PO BOX 338
DUNMORE PA
18512-0338
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax: 570-489-5563
Mailing address:
  • Phone: 570-489-5561
  • Fax: 570-489-5563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DANA WOJCIECHOWSKI
Title or Position: EXECUTIVE ADMINISTRATIVE ASSISTANT
Credential:
Phone: 570-489-5561