Provider Demographics
NPI:1063720407
Name:JUDITH KRISKIE
Entity type:Organization
Organization Name:JUDITH KRISKIE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:KRISKIE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-875-4103
Mailing Address - Street 1:PO BOX 45
Mailing Address - Street 2:613 MCKNIGHT STREET
Mailing Address - City:GORDON
Mailing Address - State:PA
Mailing Address - Zip Code:17936-0045
Mailing Address - Country:US
Mailing Address - Phone:570-875-4103
Mailing Address - Fax:
Practice Address - Street 1:129 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2175
Practice Address - Country:US
Practice Address - Phone:570-339-1828
Practice Address - Fax:570-339-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW12963251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health