Provider Demographics
NPI:1053964007
Name:LOTUS THERAPEUTIC & EMPOWERMENT SERVICES
Entity type:Organization
Organization Name:LOTUS THERAPEUTIC & EMPOWERMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-878-7757
Mailing Address - Street 1:502 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1602
Mailing Address - Country:US
Mailing Address - Phone:570-878-7757
Mailing Address - Fax:
Practice Address - Street 1:502 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1602
Practice Address - Country:US
Practice Address - Phone:570-878-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1030643090001Medicaid