Provider Demographics
NPI:1104886548
Name:PROFESSIONAL DEVELOPMENT SERVICES INC
Entity type:Organization
Organization Name:PROFESSIONAL DEVELOPMENT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-829-0795
Mailing Address - Street 1:5 PFOUTS ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-3116
Mailing Address - Country:US
Mailing Address - Phone:570-829-0795
Mailing Address - Fax:
Practice Address - Street 1:5 PFOUTS ST
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-3116
Practice Address - Country:US
Practice Address - Phone:570-829-0795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA051506Medicare ID - Type Unspecified