Healthcare Provider Details

I. General information

NPI: 1407962251
Provider Name (Legal Business Name): KENNETH SCHIRA DMIN MAMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 SOUTH 5TH STREET READING PSYCHIATRIC
READING PA
19602
US

IV. Provider business mailing address

200 NORTH 7TH STREET
LEBANON PA
17046
US

V. Phone/Fax

Practice location:
  • Phone: 610-685-2188
  • Fax:
Mailing address:
  • Phone: 717-273-1710
  • Fax: 717-273-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: