Healthcare Provider Details

I. General information

NPI: 1154546059
Provider Name (Legal Business Name): FAMILY SERVICE OF LACKAWANNA COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 JEFFERSON AVE
SCRANTON PA
18510-1630
US

IV. Provider business mailing address

615 JEFFERSON AVE
SCRANTON PA
18510-1630
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-3149
  • Fax: 570-342-5347
Mailing address:
  • Phone: 570-342-3149
  • Fax: 570-342-5347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. JOAN M ROGAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 570-342-3149