| Phoenix Rising Counseling Services, Llc | |
|
1512 E Gibson St Scranton PA 18510-1902 | |
| (570) 575-3195 | |
| (570) 347-6665 |
| Full Name | Phoenix Rising Counseling Services, Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1512 E Gibson St, Scranton, Pennsylvania |
| Authorized Official Name and Position | Rosemary D. Caolo (OWNER) |
| Authorized Official Contact | 5705753195 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phoenix Rising Counseling Services, Llc 1512 E Gibson St Scranton PA 18510-1902 Ph: (570) 575-3195 | Phoenix Rising Counseling Services, Llc 1512 E Gibson St Scranton PA 18510-1902 Ph: (570) 575-3195 |
| NPI Number | 1114386166 |
|---|---|
| Provider Enumeration Date | 02/18/2016 |
| Last Update Date | 04/03/2017 |
| Medicare PECOS PAC ID | 5799061537 |
|---|---|
| Medicare Enrollment ID | O20170411000820 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114386166 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | CW012908 (Pennsylvania) | Primary |
| Provider Name | Rosemary D. Caolo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154399962 PECOS PAC ID: 6800802018 Enrollment ID: I20060224000682 |
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