Organization
COLONIAL INTERMEDIATE UNIT #20
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEN KOSIBA (ASST MGMT FOR BILLING)
(610) 515-6439
Entity
Organization
Contact information
Practice address
780 MEMORIAL BLVD, TOBYHANNA, PA 18466-7788
(610) 515-6439
(484) 291-4135
Mailing address
6 DANFORTH DR, EASTON, PA 18045-7820
(610) 515-6439
(484) 291-4135
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/23/2025
Last updated
06/23/2025
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