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Organization
LUZERNE WYOMING COUNTIES MENTAL HEALTH MENTAL RETARDATION PROGRAM
Active
Organization
LUZERNE WYOMING COUNTIES MENTAL HEALTH MENTAL RETARDATION PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ANTOINETTE CISOWSKI (MH MR ADMINISTRATOR)
(570) 825-9441
Entity
Organization
Contact information
Practice address
111 N PENNSYLVANIA AVE, SUITE 200, WILKES BARRE, PA 18701-3511
(570) 831-7277
Mailing address
200 N RIVER STREET, TREASURER LUZERNE COUNTY, WILKES BARRE, PA 18711-1001
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/15/2007
Last updated
01/04/2016
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