Basic Information
Provider Information
NPI: 1891836078
EntityType: 2
ReplacementNPI:  
OrganizationName: LEHIGH VALLEY COMMUNITY MENTAL HEALTH INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 5349
Address2:  
City: BETHLEHEM
State: PA
PostalCode: 180150349
CountryCode: US
TelephoneNumber: 4842219136
FaxNumber: 4842219130
Practice Location
Address1: 210 N 6TH ST # 214
Address2:  
City: ALLENTOWN
State: PA
PostalCode: 181024112
CountryCode: US
TelephoneNumber: 6104324356
FaxNumber: 4842219130
Other Information
ProviderEnumerationDate: 02/09/2007
LastUpdateDate: 10/26/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: CHLEBOWSKI
AuthorizedOfficialFirstName: MELISSA
AuthorizedOfficialMiddleName: ANN
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 4842219136
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM0801X242960PAY Ambulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)

ID Information
IDTypeStateIssuerDescription
001577278000405PA MEDICAID
154906701PAGATEWAY 65 COMPLETEOTHER


Home