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General NPI Number Information
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NPI Number | 1053964007
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Entity Type | Organization
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Legal Business Name | LOTUS THERAPEUTIC & EMPOWERMENT SERVICES
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Dates
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Enumeration Date | 07/18/2019
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Last Update Date | 07/18/2019
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Provider Practice Location Address
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Address Line | 502 CHURCH ST
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City | MOOSIC
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State | PA
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Zip | 18507-1602
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Country | US
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Telephone | 570-878-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 502 CHURCH ST
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City | MOOSIC
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State | PA
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Zip | 18507-1602
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Country | US
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Telephone | 570-878-7757
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | JEAN MARIE DECKER
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Credential | LCSW
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Telephone | 570-878-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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