Provider Demographics
NPI:1396069332
Name:CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:CMSU BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, BCD
Authorized Official - Phone:570-275-5422
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-0219
Mailing Address - Country:US
Mailing Address - Phone:570-275-5422
Mailing Address - Fax:570-275-6610
Practice Address - Street 1:675 LOCUST ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815
Practice Address - Country:US
Practice Address - Phone:570-784-7804
Practice Address - Fax:570-784-8307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA32777251S00000X
251S00000X
PA327770251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA335290Medicaid
PA1000020900077Medicaid