NPIMap

Organization Active NPI

Lycoming County Crippled Children's

  • Speech-Language Pathologist
  • Williamsport, PA
National Provider Identifier
1104970227
Registry record updated Sep 28, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SL000825L Issued in PA
Legal business name
LYCOMING COUNTY CRIPPLED CHILDREN'S
Practice address
625 W Edwin St
Williamsport, PA 17701
Phone
(570) 326-0565
Fax
(570) 329-2522
NPI assigned
Jan 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Anthony P. Perrotta
Title
Executive Director
Phone
(570) 326-0565

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103G00000X PS005489L PA
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PS005489L PA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X PS005489L PA
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT000490E PA
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT002737L PA
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X PT016332L PA
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X OC006418L PA
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SL000825L PA Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SL002712L PA

Addresses

Primary practice location

625 W Edwin St
Williamsport, PA 17701

Mailing address

625 W Edwin St
Williamsport, PA 17701
Phone (570) 326-0565

Other identifiers 4

IdentifierTypeStateIssuer
100004601MedicaidPA
43093OtherPAGEISINGER HEALTH PLAN
000999239OtherPAHIGHMARK BLUE SHIELD
1000046010005MedicaidPA

Other names 1

  • L.C.C.C.S Children's Development Center Other name

National Provider Directory

National Provider Directory

Locations

625 W Edwin St
Williamsport, PA 17701
Phone (570) 326-0565

Practitioners & affiliated clinicians

Practitioners 25

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 25

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254096000000",
    "number": "1104970227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 W EDWIN ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "17701",
            "telephone_number": "570-326-0565",
            "fax_number": "570-329-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W EDWIN ST",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "17701",
            "telephone_number": "570-326-0565",
            "fax_number": "570-329-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCOMING COUNTY CRIPPLED CHILDREN'S",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2009-09-28",
        "status": "A",
        "authorized_official_last_name": "PERROTTA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "570-326-0565",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "PS005489L",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS005489L",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS005489L",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT000490E",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT002737L",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT016332L",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "PA",
            "license": "OC006418L",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL000825L",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "PA",
            "license": "SL002712L",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100004601",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEISINGER HEALTH PLAN",
            "identifier": "43093",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "000999239",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000046010005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "L.C.C.C.S Children's Development Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Williamsport, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.