=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861922791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY LINK CLINICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2017
-----------------------------------------------------
Last Update Date | 10/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 617 ARCH ST
-----------------------------------------------------
City | BELLE VERNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15012-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-979-3918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 617 ARCH ST
-----------------------------------------------------
City | BELLE VERNON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15012-1450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-979-3918
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | JUSTIN PANEPINTO
-----------------------------------------------------
Credential | CADC, CS, CPG, MSFT
-----------------------------------------------------
Telephone | 412-979-3918
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------