=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407999766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2007
-----------------------------------------------------
Last Update Date | 06/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 E MARKET ST
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-275-4962
-----------------------------------------------------
Fax | 570-275-5754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 219
-----------------------------------------------------
City | DANVILLE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17821-0219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-275-5422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. RICHARD D. BEACH
-----------------------------------------------------
Credential | LCSW, BCD
-----------------------------------------------------
Telephone | 570-275-5422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------