# LUZERNE WYOMING COUNTIES MENTAL HEALTH MENTAL RETARDATION PROGRAM

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154455061
- **Authorized official:** MRS. ANTOINETTE CISOWSKI (MH MR ADMINISTRATOR)
- **Authorized official phone:** (570) 825-9441

## Contact information

- **Practice address:** 111 N PENNSYLVANIA AVE, SUITE 200, WILKES BARRE, PA 18701-3511
- **Practice address phone:** (570) 831-7277
- **Mailing address:** 200 N RIVER STREET, TREASURER LUZERNE COUNTY, WILKES BARRE, PA 18711-1001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | Yes |
| 171M00000X | Case Manager/Care Coordinator | — | — | Yes |

## Other

- **Enumeration date:** 03/15/2007
- **Last updated:** 01/04/2016