NPIMap

Organization Active NPI

Lycoming-Clinton MHMR Program

  • Psychologist
  • Williamsport, PA
National Provider Identifier
1770636573
Registry record updated Dec 22, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PS004649L Issued in PA
Legal business name
LYCOMING-CLINTON MHMR PROGRAM
Practice address
200 East Street
The Sharwell Building
Williamsport, PA 17701
Phone
(570) 326-0924
Fax
(570) 326-1348
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2015

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

Authorized official

Name
Doborah M Duffy
Title
Administrator
Phone
(570) 326-7895

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X PS004649L PA Primary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Case Management Agency 251B00000X
Nursing Care Agency 251J00000X
Public Health or Welfare Agency 251K00000X
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

200 East Street
The Sharwell Building
Williamsport, PA 17701

Mailing address

200 East Street
The Sharwell Building
Williamsport, PA 17701
Phone (570) 326-0924

Other names 1

  • lycoming-clinton joinder board Other name

National Provider Directory

National Provider Directory
Tax ID family
Lycoming-Clinton Joinder Board4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450742400000",
    "number": "1770636573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 EAST STREET",
            "address_2": "THE SHARWELL BUILDING",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "17701",
            "telephone_number": "570-326-0924",
            "fax_number": "570-326-1348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EAST STREET",
            "address_2": "THE SHARWELL BUILDING",
            "city": "WILLIAMSPORT",
            "state": "PA",
            "postal_code": "17701",
            "telephone_number": "570-326-0924",
            "fax_number": "570-326-1348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYCOMING-CLINTON MHMR PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2015-12-22",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "DOBORAH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "570-326-7895"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS004649L",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "lycoming-clinton joinder board",
            "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 Dec 22, 2015; 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.