Basic Information
| Provider Information | |||||||||
| NPI: | 1831360528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CEN CLEAR CHILD SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1633 PHILIPSBURG BIGLER HWY | ||||||||
| Address2: | |||||||||
| City: | PHILIPSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168668112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Practice Location | |||||||||
| Address1: | 580 OLD ROUTE 322 | ||||||||
| Address2: | |||||||||
| City: | PHILIPSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168668004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143425678 | ||||||||
| FaxNumber: | 8143422755 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2008 | ||||||||
| LastUpdateDate: | 10/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | RAAB | ||||||||
| AuthorizedOfficialFirstName: | PAULINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8143425678 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 406200 | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1000053220046 | 05 | PA | MEDICAID | 1000053220069 | 05 | PA | MEDICAID |