Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Organization
WAYNE MEMORIAL COMMUNITY HEALTH CENTERS
Active
Other names
Honesdale Behavioral Health
Organization subpart
No
Provider details
NPI number
Authorized official
FREDERICK JACKSON (EXECUTIVE DIRECTOR)
(570) 253-8450
Entity
Organization
Contact information
Practice address
600 MAPLE AVE STE 6, HONESDALE, PA 18431-1436
(570) 253-8219
(570) 253-8242
Mailing address
601 PARK ST, HONESDALE, PA 18431-1445
(570) 253-8226
(570) 253-8228
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
PA
2084P0800X
Psychiatry Physician
—
PA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
PA
Other
Enumeration date
07/21/2014
Last updated
07/21/2014
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