Healthcare Provider Details

I. General information

NPI: 1235264912
Provider Name (Legal Business Name): THE COMMUNITY INTERVENTION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 N 6TH AVE
SCRANTON PA
18503-2101
US

IV. Provider business mailing address

445 N 6TH AVE
SCRANTON PA
18503-2101
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-4298
  • Fax: 570-343-2804
Mailing address:
  • Phone: 570-342-4298
  • Fax: 570-343-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1016532920002
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerCCBH GRP

VIII. Authorized Official

Name: MRS. TARA QUINN FINNERTY
Title or Position: DIRECTOR
Credential:
Phone: 570-342-4298