Organization
COLONIAL INTERMEDIATE UNIT 20
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER WOLFEL DO (EXECUTIVE DIRECTOR)
(610) 515-6403
Entity
Organization
Contact information
Practice address
1115 LINDEN STREET, LIBERTY HIGH SCHOOL, BETHLEHEM, PA 18018-2999
(610) 691-7200
Mailing address
6 DANFORTH RD, EASTON, PA 18045-7820
(610) 515-6440
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
235100
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100754460
—
PA
Enumeration date
09/30/2009
Last updated
02/09/2021
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