=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245601392
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SALISBURY BEHAVIORAL HEALTH DBA NEW STORY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2015
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2700 COMMERCE DR
-----------------------------------------------------
City | HARRISBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17110-9365
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-901-9906
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 PERIMETER CENTER PKWY NE STE 750
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30346-1318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-630-7290
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SVP FINANCIAL SERVICES
-----------------------------------------------------
Name | JENNIFER D LOZANO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-630-7290
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number | BH002849
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------