| Irene Stacy Cmhc | |
|
112 Hillvue Drive Butler PR 16001-3498 | |
| (724) 287-0791 | |
| (724) 287-2730 |
| Full Name | Irene Stacy Cmhc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 112 Hillvue Drive, Butler, Puerto Rico |
| Authorized Official Name and Position | Roger Kelly (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 7242870791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Irene Stacy Cmhc 112 Hillvue Drive Butler PR 16001-3498 Ph: (724) 287-0791 | Irene Stacy Cmhc 112 Hillvue Drive Butler PR 16001-3498 Ph: (724) 287-0791 |
| NPI Number | 1518142249 |
|---|---|
| Provider Enumeration Date | 12/31/2007 |
| Last Update Date | 12/31/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518142249 | NPI | - | NPPES |
| 100003515 0119 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | COUNTY APPROVAL (Pennsylvania) | Primary |