1700405461 NPI number — KEYSTONE BEHAVIOR SERVICES, LLC

Table of content: MRS. SARAH REBECCA SPINNER LCSW (NPI 1598599623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700405461 NPI number — KEYSTONE BEHAVIOR SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEYSTONE BEHAVIOR SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700405461
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
334 HIGHLARK DR STE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARKSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18704-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-852-9217
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-5442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-362-2348
Provider Business Practice Location Address Fax Number:
570-565-0024
Provider Enumeration Date:
04/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KISHBAUGH
Authorized Official First Name:
JACQUELINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
570-852-9217

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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