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
—
—
Other
Enumeration date
03/15/2007
Last updated
01/04/2016
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