Healthcare Provider Details

I. General information

NPI: 1679486906
Provider Name (Legal Business Name): EMBRACE REAL HEALING, MENTAL HEALTH THERAPY LCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2241 SHOPPES BLVD
MOOSIC PA
18507-2147
US

IV. Provider business mailing address

2241 SHOPPES BLVD
MOOSIC PA
18507-2147
US

V. Phone/Fax

Practice location:
  • Phone: 570-559-3837
  • Fax:
Mailing address:
  • Phone: 570-559-3837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: EDWARD RYAN HAYES
Title or Position: LCSW
Credential: LCSW
Phone: 570-559-3837