Provider Demographics
NPI:1154546059
Name:FAMILY SERVICE OF LACKAWANNA COUNTY
Entity type:Organization
Organization Name:FAMILY SERVICE OF LACKAWANNA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:570-342-3149
Mailing Address - Street 1:615 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1630
Mailing Address - Country:US
Mailing Address - Phone:570-342-3149
Mailing Address - Fax:570-342-5347
Practice Address - Street 1:615 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1630
Practice Address - Country:US
Practice Address - Phone:570-342-3149
Practice Address - Fax:570-342-5347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA083426Medicare PIN