=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912373853
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NICHOLAS J. TELINCHO JR. LCSW
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2015
-----------------------------------------------------
Last Update Date | 08/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 CHASE ST
-----------------------------------------------------
City | WEST PITTSTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18643-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-603-0666
-----------------------------------------------------
Fax | 570-299-7777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 CHASE ST
-----------------------------------------------------
City | WEST PITTSTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18643-2011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-603-0666
-----------------------------------------------------
Fax | 570-299-7777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. NICHOLAS J. TELINCHO JR.
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 570-603-0666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | CW014087
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------