Basic Information
| Provider Information | |||||||||
| NPI: | 1063412120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACK | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | BELLOMO | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PCS, INC. | ||||||||
| Address2: | 632 CUMBERLAND ST | ||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172731710 | ||||||||
| FaxNumber: | 7172731416 | ||||||||
| Practice Location | |||||||||
| Address1: | PCS, INC. | ||||||||
| Address2: | 1 GREYSTONE RD | ||||||||
| City: | CARLISLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172459255 | ||||||||
| FaxNumber: | 7172459198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 05/16/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW013916 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SC05973 | NJ | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.