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General NPI Number Information
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NPI Number | 1083736367
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Entity Type | Organization
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Legal Business Name | COLONIAL INTERMEDIATE UNIT 20
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 02/09/2021
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Provider Practice Location Address
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Address Line | 1110 W MAIN ST STROUDSBURG HIGH SCHOOL
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City | STROUDSBURG
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State | PA
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Zip | 18360-1397
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Country | US
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Telephone | 610-515-6477
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Fax | 610-515-6457
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Provider Business Mailing Address
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Address Line | 6 DANFORTH DR
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City | EASTON
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State | PA
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Zip | 18045-7899
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Country | US
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Telephone | 610-252-5550
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Fax | 610-515-6524
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. CHRISTOPHER WOLFEL
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Credential | D. ED
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Telephone | 610-252-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 235100
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License Number State | PA
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