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Contact Information

LYCOMING COUNTY CRIPPLED CHILDREN'S
625 W EDWIN ST
WILLIAMSPORT, PA17701
 Phone: 570-326-0565
 Fax: 570-329-2522
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Speech-Language Pathologist

235Z00000X 15 Speech Language Pathologist
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical Neuropsychologist

103G00000X
 

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Physical Therapist

225100000X 65 Physical Therapist in Private Practice
 

Psychologist

103T00000X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for LYCOMING COUNTY CRIPPLED CHILDREN'S

NPI # 1104970227
LBN Legal business name LYCOMING COUNTY CRIPPLED CHILDREN'S
Authorized official ANTHONY PERROTTA - (EXECUTIVE DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 01/23/2007
Last updated 09/28/2009 - About 17 years ago
Identifiers
PA License # OC006418L
PA License # PS005489L
PA License # PT000490E
PA License # PT002737L
PA License # PT016332L
PA License # SL000825L
PA License # SL002712L
PA Medicaid 100004601
PA Medicaid 1000046010005
PA Other 43093 GEISINGER HEALTH PLAN
PA Other 000999239 HIGHMARK BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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