Organization
CENTERVILLE CLINICS , INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA MARTOS (DIRECTOR PERSONNEL/FINANCE)
(724) 632-6801
Entity
Organization
Contact information
Practice address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
—
—
174400000X
Specialist
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001804928
HIGHMARK BLUE SHIELD
PA
01
—
031218
HGSA - MEDICARE
PA
05
—
1007288440027
—
PA
01
—
328834A336347
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
11/08/2005
Last updated
06/11/2010
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