Organization
LYCOMING COUNTY CRIPPLED CHILDREN'S
Active
Other names
L.C.C.C.S Children's Development Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY P. PERROTTA (EXECUTIVE DIRECTOR)
(570) 326-0565
Entity
Organization
Contact information
Practice address
625 W EDWIN ST, WILLIAMSPORT, PA 17701
(570) 326-0565
(570) 329-2522
Mailing address
625 W EDWIN ST, WILLIAMSPORT, PA 17701
(570) 326-0565
(570) 329-2522
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PS005489L
PA
103T00000X
Psychologist
PS005489L
PA
103TC0700X
Clinical Psychologist
PS005489L
PA
225100000X
Physical Therapist
PT000490E
PA
225100000X
Physical Therapist
PT002737L
PA
225100000X
Physical Therapist
PT016332L
PA
225X00000X
Occupational Therapist
OC006418L
PA
235Z00000X
Speech-Language Pathologist
Primary
SL000825L
PA
235Z00000X
Speech-Language Pathologist
SL002712L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000999239
HIGHMARK BLUE SHIELD
PA
05
—
100004601
—
PA
05
—
1000046010005
—
PA
01
—
43093
GEISINGER HEALTH PLAN
PA
Enumeration date
01/23/2007
Last updated
09/28/2009
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