Provider Demographics
NPI:1053522151
Name:POCONO THERAPEUTIC SERVICES LLC
Entity type:Organization
Organization Name:POCONO THERAPEUTIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-424-8657
Mailing Address - Street 1:419A KING ST
Mailing Address - Street 2:
Mailing Address - City:E STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-1206
Mailing Address - Country:US
Mailing Address - Phone:570-424-8657
Mailing Address - Fax:570-424-9783
Practice Address - Street 1:419A KING ST
Practice Address - Street 2:
Practice Address - City:E STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1206
Practice Address - Country:US
Practice Address - Phone:570-424-8657
Practice Address - Fax:570-424-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW012856251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health