1801657366 NPI number — EMBARK THERAPY, LLC

Table of content: REBECCA JANE FRANCES KERWIN BA, MHP (NPI 1225812340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801657366 NPI number — EMBARK THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMBARK THERAPY, 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:
1801657366
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 MUTCHLER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17821-7809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-630-7898
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 HIGHWAY 315 BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-630-7898
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHROYER
Authorized Official First Name:
JENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-630-7898

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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