Healthcare Provider Details

I. General information

NPI: 1215035019
Provider Name (Legal Business Name): CARBON LEHIGH INTERMEDIATE UNIT #21
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 INDEPENDENCE DRIVE
SCHNECKSVILLE PA
18078-4821
US

IV. Provider business mailing address

4210 INDEPENDENCE DRIVE
SCHNECKSVILLE PA
18078-4821
US

V. Phone/Fax

Practice location:
  • Phone: 610-769-4111
  • Fax: 610-769-1250
Mailing address:
  • Phone: 610-769-4111
  • Fax: 610-769-1250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number205750
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number244010
License Number StatePA

VIII. Authorized Official

Name: MR. ROBERT J KEEGAN JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 610-769-4111