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NPI Code Detail

MEDICARE: BLOOMSBURG PSYCHOTHERAPY CENTER LLC

MEDICARE: BLOOMSBURG PSYCHOTHERAPY CENTER 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
1101YP2500XProfessional Counselor
2103T00000XPsychologistPS007710LPA
3103T00000XPsychologist
4104100000XSocial Worker
51041C0700XClinical Social Worker

General Provider Information

NPI Number : 1487651170
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLOOMSBURG PSYCHOTHERAPY CENTER LLC
Provider Business Mailing Address
First Line : 816 CENTRAL RD
Second Line :
City : BLOOMSBURG
State : PA
Zip : 17815-8976
Country : US
Telephone Number : 570-387-1832
Fax Number : 570-387-5103
Provider Business Practice Location Address
First Line : 816 CENTRAL RD
Second Line :
City : BLOOMSBURG
State : PA
Zip : 17815-8976
Country : US
Telephone Number : 570-387-1832
Fax Number : 570-387-5103
Authorized Official
Title or Position : OWNER/LCSW
Name : MS. RONDA BARTO
Credential : LCSW
Telephone Number : 570-387-1832
Provider Enumeration Date : 07/07/2005
Last Update Date : 12/30/2022

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