MEDICARE: NORTHEAST COUNSELING SERVICE

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	2084P0804X	Child & Adolescent Psychiatry Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952903601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST COUNSELING SERVICE

Provider Business Mailing Address
First Line	:	750 E BROAD ST
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-6835
Country	:	US
Telephone Number	:	570-455-6385
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 W 23RD ST
Second Line	:
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-1541
Country	:	US
Telephone Number	:	570-455-6385
Fax Number	:

Authorized Official
Title or Position	:	MIS DIRECTOR
Name	:	RICH ZABINSKI
Credential	:
Telephone Number	:	570-455-6385

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	11/09/2020

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Directions to “NORTHEAST COUNSELING SERVICE ” Practice Location

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