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General NPI Number Information
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NPI Number | 1023545696
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL MEDICINE ASSOCIATES OF NORTHEASTERN LENNSYLVANIA, LLC
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Dates
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Enumeration Date | 05/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 480 PIERCE ST STE 303
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-690-5159
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Fax |
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Provider Business Mailing Address
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Address Line | 480 PIERCE ST STE 303
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City | KINGSTON
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State | PA
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Zip | 18704-5512
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Country | US
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Telephone | 570-690-5159
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MR. FRANCISCO SALAS GUERRA
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Credential |
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Telephone | 570-690-5159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD435626
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License Number State | PA
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