Provider Demographics
NPI:1801372123
Name:MOUNT CARMEL MENTAL HEALTH CENTER LLC
Entity type:Organization
Organization Name:MOUNT CARMEL MENTAL HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANTARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PSYCHOLOGIS
Authorized Official - Phone:570-933-4179
Mailing Address - Street 1:316 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT CARMEL
Mailing Address - State:PA
Mailing Address - Zip Code:17851-2253
Mailing Address - Country:US
Mailing Address - Phone:570-933-4179
Mailing Address - Fax:570-339-1924
Practice Address - Street 1:129 E 5TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT CARMEL
Practice Address - State:PA
Practice Address - Zip Code:17851-2175
Practice Address - Country:US
Practice Address - Phone:570-933-4179
Practice Address - Fax:570-339-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006073L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty