Healthcare Provider Details

I. General information

NPI: 1417136102
Provider Name (Legal Business Name): SCRANTON COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 CHERRY ST
SCRANTON PA
18505-1505
US

IV. Provider business mailing address

329 CHERRY ST
SCRANTON PA
18505-1505
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-6100
  • Fax: 570-969-8955
Mailing address:
  • Phone: 570-348-6100
  • Fax: 570-969-8955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number232500
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1000019500010
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. SALVATORE SANTOLI
Title or Position: INTERIM PRESIDENT/CEO
Credential: M.S.
Phone: 570-348-6100