MEDICARE: AMBER PETCHONKA

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1922953199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMBER PETCHONKA

Provider Business Mailing Address
First Line	:	1135 VALLEY VIEW DR
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-5901
Country	:	US
Telephone Number	:	484-860-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 VALLEY VIEW DR
Second Line	:
City	:	BANGOR
State	:	PA
Zip	:	18013-5901
Country	:	US
Telephone Number	:	484-860-4002
Fax Number	:

Authorized Official
Title or Position	:	LICENSED THERAPIST
Name	:	AMBER PETCHONKA
Credential	:	ATR-BC, LPC
Telephone Number	:	484-860-4002

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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