Healthcare Provider Details

I. General information

NPI: 1821304544
Provider Name (Legal Business Name): FORENSIC COUNSELING ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2010
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 POCONO BLVD. FORENSIC COUNSELING ASSOCIATES, LLC
MT. POCONO PA
18344
US

IV. Provider business mailing address

1385 POCONO BLVD. FORENSIC COUNSELING ASSOCIATES, LLC
MT. POCONO PA
18344
US

V. Phone/Fax

Practice location:
  • Phone: 570-460-4379
  • Fax: 570-421-3600
Mailing address:
  • Phone: 570-460-4379
  • Fax: 570-421-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LORI BERTANZETTI
Title or Position: OWNER
Credential: LCSW
Phone: 570-460-4379