Organization
LYCOMING-CLINTON MHMR PROGRAM
Active
Other names
lycoming-clinton joinder board
Organization subpart
No
Provider details
NPI number
Authorized official
DOBORAH M DUFFY (ADMINISTRATOR)
(570) 326-7895
Entity
Organization
Contact information
Practice address
200 EAST STREET, THE SHARWELL BUILDING, WILLIAMSPORT, PA 17701
(570) 326-0924
(570) 326-1348
Mailing address
200 EAST STREET, THE SHARWELL BUILDING, WILLIAMSPORT, PA 17701
(570) 326-0924
(570) 326-1348
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS004649L
PA
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
01/18/2007
Last updated
12/22/2015
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