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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