Provider Demographics
NPI:1063410207
Name:IRENE STACY COMMUNITY MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:IRENE STACY COMMUNITY MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-287-0791
Mailing Address - Street 1:112 HILLVUE DR
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-3426
Mailing Address - Country:US
Mailing Address - Phone:724-287-0791
Mailing Address - Fax:724-287-8354
Practice Address - Street 1:112 HILLVUE DR
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-3426
Practice Address - Country:US
Practice Address - Phone:724-287-0791
Practice Address - Fax:724-287-8354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA423000101YP2500X, 101YM0800X
PA101013101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100003515Medicaid
PA1007698OtherCBHNP-GATEWAY
PA151407OtherMEDICARE PTAN
PA660502OtherHIGHMARK
PA201030OtherUPMC