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General NPI Number Information
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NPI Number | 1184797961
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Entity Type | Organization
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Legal Business Name | SAINT VINCENT SERENITY PROGRAM
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 06/08/2011
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Provider Practice Location Address
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Address Line | 1910 SASSAFRAS ST SUITE 100
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City | ERIE
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State | PA
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Zip | 16502-2716
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Country | US
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Telephone | 814-452-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1910 SASSAFRAS ST SUITE 100
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City | ERIE
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State | PA
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Zip | 16502-2716
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Country | US
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Telephone | 814-452-5555
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Fax |
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. SCOTT A WHALEN
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Credential | PHD, FACHE
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Telephone | 814-452-5111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 252013
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License Number State | PA
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