| Lycoming Therapeutic Wrap Around Services, Inc | |
|
1521 Washington Blvd Williamsport PA 17701-5426 | |
| (570) 322-5051 | |
| (570) 322-6788 |
| Full Name | Lycoming Therapeutic Wrap Around Services, Inc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 1521 Washington Blvd, Williamsport, Pennsylvania |
| Authorized Official Name and Position | John S Neil (OWNER) |
| Authorized Official Contact | 5703225051 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lycoming Therapeutic Wrap Around Services, Inc 1521 Washington Blvd Williamsport PA 17701-5426 Ph: (570) 322-5051 | Lycoming Therapeutic Wrap Around Services, Inc 1521 Washington Blvd Williamsport PA 17701-5426 Ph: (570) 322-5051 |
| NPI Number | 1831245570 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831245570 | NPI | - | NPPES |
| 1011074990002 | Medicaid | PA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PS008553L (Pennsylvania) | Primary |
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