| NPI | 1497167167 |
|---|---|
| Other Name | KEYSTONE BLUE HEN PC |
| Entity Type | Organization |
| Authorized Contact | SCOT MASON DEPUE CEO 484-769-7626 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA MD426302) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: PA PC002868) |
| 207P00000X Emergency Medicine (Licence: PA MD426302) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2014-05-28 |