Organization
AVIS BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS PATRICIA ANN DERSHEM MSS LCSW (PRESIDENT OWNER PSYCHOTHERAPIST)
(570) 753-3620
Entity
Organization
Contact information
Practice address
302 WEST CENTRAL AVE., AVIS, PA 17721-1070
(570) 753-3620
(570) 753-3620
Mailing address
302 WEST CENTRAL AVE., PO BOX 1070, AVIS, PA 17721-1070
(570) 753-3620
(570) 753-3620
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW008439L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
083604
MEDICARE
PA
01
—
1617662
HIGHMARK BC/BS
PA
01
—
2117726
CIGNA/GEISINGER
PA
01
—
474483
VALUE OPTIONS
PA
01
—
817938
FIRST PRIORITY HEALTH
PA
Enumeration date
08/15/2006
Last updated
08/22/2020
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