Organization
KALEIDASCOPE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANICE REARDON LANE MS (EXECUTIVE DIRECTOR)
(814) 824-4515
Entity
Organization
Contact information
Practice address
4934 PEACH ST FL 2, ERIE, PA 16509-2043
(814) 824-4515
(814) 824-4533
Mailing address
4934 PEACH ST FL 2, ERIE, PA 16509-2043
(814) 824-4515
(814) 824-4533
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
Primary
PS006926L
PA
106H00000X
Marriage & Family Therapist
MF000031
PA
251B00000X
Case Management Agency
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
08/29/2007
Last updated
05/13/2019
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