Organization
CENTRE COUNTY MH-ID-EI/D&A
Active
Other names
EI
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS J MCDERMOTT (ADMINISTRATOR)
(814) 355-6782
Entity
Organization
Contact information
Practice address
3500 E COLLEGE AVE, SUITE 1200, STATE COLLEGE, PA 16801-7569
(814) 355-6782
(814) 355-6985
Mailing address
3500 E COLLEGE AVE, SUITE 1200, STATE COLLEGE, PA 16801-7569
(814) 355-6782
(814) 355-6985
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007296630003
—
PA
Enumeration date
04/30/2007
Last updated
10/06/2015
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