MEDICARE: POCONO THERAPEUTIC SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	CW012856	PA

General Provider Information

NPI Number	:	1053522151
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POCONO THERAPEUTIC SERVICES LLC

Provider Business Mailing Address
First Line	:	419A KING ST
Second Line	:
City	:	E STROUDSBURG
State	:	PA
Zip	:	18301-1206
Country	:	US
Telephone Number	:	570-424-8657
Fax Number	:	570-424-9783

Provider Business Practice Location Address
First Line	:	419A KING ST
Second Line	:
City	:	E STROUDSBURG
State	:	PA
Zip	:	18301-1206
Country	:	US
Telephone Number	:	570-424-8657
Fax Number	:	570-424-9783

Authorized Official
Title or Position	:	OWNER
Name	:	DOROTHY B. PARKER
Credential	:	LCSW
Telephone Number	:	570-424-8657

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	08/22/2020

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