=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104556620
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIZON MENTAL HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2022
-----------------------------------------------------
Last Update Date | 11/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 341 WYOMING AVE STE 8
-----------------------------------------------------
City | WEST PITTSTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18643-2839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 445-255-7877
-----------------------------------------------------
Fax | 802-284-3210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 E LAFAYETTE PL
-----------------------------------------------------
City | WILKES BARRE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18702-2250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-406-1107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CHERYL RITTFELDT
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 570-406-1107
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------