Provider Directory for Members

Transcription

1 Provider Directory for Members Provider Directory Listing for HealthChoices North East Page 1 of 60 Page # Full Directory 2 Assertive Community Treatment (CTT) 3 Behavioral Health Rehabilitation Services for Children and Adolescents 5 BHRSCA Evaluation Services 9 Blended Case Management 10 Clozaril Support Services 11 Community Residential Rehab - Group Home 12 Community Residential Rehab - Host Home 13 Drug & Alcohol Buprenorphine Treatment 14 Drug & Alcohol Case Management 15 Drug & Alcohol Halfway House 16 Drug & Alcohol Inpatient Detox 17 Drug & Alcohol Inpatient Rehab 18 Drug & Alcohol Intensive Outpatient 19 Drug & Alcohol Level of Care Assessment 20 Drug & Alcohol Methadone Maintenance 21 Drug & Alcohol Non-hospital Detox 22 Drug & Alcohol Non-hospital Rehab 3B 23 Drug & Alcohol Non-hospital Rehab 3C 24 Drug & Alcohol Outpatient 26 Drug & Alcohol Partial Hospitalization 27 Electroconvulsive Therapy - Inpatient 28 Electroconvulsive Therapy - Outpatient 29 Family-based Mental Health Services 30 General Hospital - Lab Services 31 Inpatient Mental Health 32 Inpatient Mental Health Sub-acute 33 Intensive Case Management 34 Mental Health Crisis - Mobile 35 Mental Health Crisis - Residential 36 Mental Health Crisis - Telephone 37 Mental Health Crisis - Walk-in 38 Mental Health Outpatient 45 Mental Health Partial Hospitalization (non-acute) 47 Mobile Mental Health Treatment 48 Multisystemic Therapy 49 Neuropsychological Testing 50 Peer Support Specialist 51 Psychiatric Rehabilitation - Clubhouse 52 Psychiatric Rehabilitation - Mobile 53 Psychiatric Rehabilitation - Site-based 54 Psychological Testing 57 Residential Treatment Facility - JCAHO 58 Residential Treatment Facility - Non-JCAHO 59 Resource Coordination 60 Telepsychiatry Page 1 of 60

2 Page 2 of 60 Assertive Community Treatment (CTT) West Washington Street Nanticoke, PA Page 2 of 60

3 Page 3 of 60 Behavioral Health Rehabilitation Services for Children and Adolescents Autism Behavioral Services, Inc LaJeunesse, Charles, Ph.D. Children's Behavioral Health Services, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Family Enrichment Center, P.C Matthews, Michael, Ph.D. Fremont, Jeffrey, Ph.D Friendship House KidsPeace National Centers, Inc Luzerne Intermediate Unit Mark K. Sowcik, PhD Sowcik, Mark, Ph.D Wyoming Avenue Exeter, PA Woodward Hill Road Edwardsville, PA West Tioga Street Tunkhannock, PA Wyoming County 335 South Franklin Street Wilkes-Barre, PA Wyoming Avenue Kingston, PA Wyoming Avenue Scranton, PA Wyoming Avenue Forty-Fort, PA Maple Street Scranton, PA Pittston Avenue 1st Floor, Suite 3 Scranton, PA Tioga Avenue Kingston, PA Main Street Luzerne, PA Raystown Road Huntingdon, PA Huntingdon County 140 Pennsylvania Avenue Sunbury, PA Northumberland County State Route 706 Suite 1 and 2 Montrose, PA B Emmitsburg Road Gettysburg, PA Adams County 1990 West Third Street Williamsport, PA Lycoming County 25 East Park Avenue Suite 8 DuBois, PA Clearfield County 25 Rothermel Drive Suite A Yeagertown, PA Mifflin County 3020 Research Drive State College, PA Centre County North Main Street Carbondale, PA Lincoln Way East Chambersburg, PA Franklin County 627 Main Street 3rd Floor Honesdale, PA Wayne County 651 Albright Avenue York, PA York County 665 Rodi Road Pittsburgh, PA Allegheny County Page 3 of 60

4 Page 4 of 60 Behavioral Health Rehabilitation Services for Children and Adolescents (continued) Roger L. Smothers Smothers, Roger, M.S. Salisbury Behavioral Health Inc Scranton Counseling Center Scranton Counseling Center Step-By-Step, Inc Youth Advocate Programs, Inc Youth Advocate Programs, Inc South Elmer Avenue Suite # 115 Sayre, PA Bradford County 120 East 3rd Street Rear Entrance Berwick, PA Columbia County 130 West Washington Street Nanticoke, PA East Broad Street Hazleton, PA State Route 267 Friendsville, PA Wyoming Avenue Wyoming, PA Adams Avenue 326 Adams Avenue 744 Kidder Street Cross Valley Commons Wilkes-Barre, PA Main Street Suite 101 Peckville, PA Public Avenue 2nd Floor Montrose, PA Page 4 of 60

5 Page 5 of 60 BHRSCA Evaluation Services Autism Behavioral Services, Inc LaJeunesse, Charles, Ph.D. Brooke E. Egbert, PsyD, LLC Egbert, Brooke, Psy.D. Children's Behavioral Health Services, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Elizabeth A. Ciaravino, PhD Ciaravino, Elizabeth, Ph.D. Elizabeth A. Ciaravino, PhD Ciaravino, Elizabeth, Ph.D. Family Enrichment Center, P.C Matthews, Michael, Ph.D. Friendship House Geisinger Clinic Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Wyoming Avenue Exeter, PA Wyoming Avenue Kingston, PA Woodward Hill Road Edwardsville, PA West Tioga Street Tunkhannock, PA Wyoming County 335 South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Wyoming Avenue Kingston, PA Stafford Avenue PA Treatment and Healing Scranton, PA Collan Park PA Treatment and Healing Honesdale, PA Wayne County 541 Wyoming Avenue Scranton, PA Maple Street Scranton, PA North Academy Avenue Danville, PA Montour County 1015 Penn Avenue Suite 201 Wyomissing, PA Berks County 1021 Springboard Drive Hershey, PA Dauphin County 1150 Wyoming Avenue Wyoming, PA East Market Street Pressley Ridge York, PA York County 20 Depot Street Suite 103 Lewistown, PA Mifflin County 2030 Thistle Drive Suite 205 Spring Grove, PA York County 218 West 6th Street Berwick, PA Columbia County 25 Rothermel Drive, Suite A NHS Human Services Yeagertown, PA Mifflin County Page 5 of 60

6 Page 6 of 60 BHRSCA Evaluation Services (continued) Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D. KidsPeace National Centers, Inc Luzerne Intermediate Unit Luzerne Intermediate Unit Mark K. Sowcik, PhD Betts, Jennifer, Psy.D. Richards, Maria, Psy.D. Scott, William, M.S. Sowcik, Mark, Ph.D. Muto, Nicholas, M.S Muto, Nicholas, M.S Muto, Nicholas, M.S Pottsville-Minersville Highway, Suite 150 New Story Minersville, PA Schuylkill County 353 Rear Market Street Sunbury, PA Northumberland County 555 Ryan Run Road, Suite 201 New Story York, PA York County 619 Mahantongo Street NHS Human Services Pottsville, PA Schuylkill County 751 Industrial Park Road Throop, PA North Fourth Street - Second Floor Lehighton, PA Carbon County 101 Pittston Avenue 1st Floor, Suite 3 Scranton, PA Tioga Avenue Kingston, PA Tioga Avenue Kingston, PA Main Street Luzerne, PA Progress Place Towanda, PA Bradford County 1418 Main Street Suite 101 Peckville, PA Ellsworth Drive P.O. Box 310 South Montrose, PA Raystown Road Huntingdon, PA Huntingdon County 140 Pennsylvania Avenue Sunbury, PA Northumberland County State Route 706 Suite 1 and 2 Montrose, PA B Emmitsburg Road Gettysburg, PA Adams County 1990 West Third Street Williamsport, PA Lycoming County 2000 Northwestern Drive Coal Township, PA Northumberland County 227 Academy Street Williamsport, PA Lycoming County Page 6 of 60

7 Page 7 of 60 BHRSCA Evaluation Services (continued) Reinhardt, John, Ph.D Reinhardt, John, Ph.D Roger L. Smothers Smothers, Roger, M.S. Roger L. Smothers Smothers, Roger, M.S. Salisbury Behavioral Health Inc Scranton Counseling Center Scranton Counseling Center Step-By-Step, Inc Tietbohl, Phillip, Ph.D Tietbohl, Phillip, Ph.D Youth Advocate Programs, Inc East Park Avenue Suite 8 DuBois, PA Clearfield County 25 Rothermel Drive Suite A Yeagertown, PA Mifflin County 3020 Research Drive State College, PA Centre County North Main Street Carbondale, PA Lincoln Way East Chambersburg, PA Franklin County 627 Main Street 3rd Floor Honesdale, PA Wayne County 651 Albright Avenue York, PA York County 665 Rodi Road Pittsburgh, PA Allegheny County 703 South Elmer Avenue Suite # 115 Sayre, PA Bradford County 912 Main Street Suite 202 Stroudsburg, PA Monroe County 120 East 3rd Street Rear Entrance Berwick, PA Columbia County 130 West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Hickory Street Scranton, PA Industrial Park Road Lake Ariel, PA Wayne County 433 Church Street New Milford, PA Public Avenue 2nd Floor Montrose, PA Wyoming Avenue Wyoming, PA Adams Avenue 326 Adams Avenue 744 Kidder Street Cross Valley Commons Wilkes-Barre, PA Penn Avenue West Lawn, PA Berks County One Norwegian Plaza Pottsville, PA Schuylkill County 1418 Main Street Suite 101 Peckville, PA Page 7 of 60

8 Page 8 of 60 BHRSCA Evaluation Services (continued) Youth Advocate Programs, Inc Zemlan, Natalie, M.A Public Avenue 2nd Floor Montrose, PA North Lehigh Street Frackville, PA Schuylkill County Page 8 of 60

9 Page 9 of 60 Blended Case Management Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Lourdesmont Good Shepherd Youth & Family Services Scranton Counseling Center South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Wyoming Avenue Scranton, PA State Route 706 Suite 1 and 2 Montrose, PA North Main Street Carbondale, PA West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Adams Avenue Page 9 of 60

10 Page 10 of 60 Clozaril Support Services Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Scranton Counseling Center Scranton Counseling Center Wright Center Medical Group PC, The Sahadevan, Adharsh, M.D. Wright Center Medical Group PC, The Sahadevan, Adharsh, M.D. Wright Center Medical Group PC, The Sahadevan, Adharsh, M.D. 335 South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Wyoming Avenue Kingston, PA Bridge Street Tunkhannock, PA Wyoming County North Main Street Carbondale, PA West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Luzerne Street Scranton, PA Adams Avenue 1145 Northern Boulevard Clarks Summit, PA South Washington Avenue Jermyn, PA Madison Avenue Scranton, PA Page 10 of 60

11 Page 11 of 60 Community Residential Rehab - Group Home Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc East Noble Street Nanticoke, PA South Franklin Street Wilkes-Barre, PA Page 11 of 60

12 Page 12 of 60 Community Residential Rehab - Host Home Children's Service Center of Wyoming Valley, Inc CONCERN Professional Services for Children, Youth & Families Diversified Treatment Alternatives National Mentor Healthcare, LLC. dba PA MENTOR South Franklin Street Wilkes-Barre, PA Scranton/Carbondale Highway Eynon, PA Fairfield Road Lewisburg, PA Union County 312 State Highway 315 Pittston, PA North Cameron Street Suite 401 Harrisburg, PA Dauphin County 1075 Waterdam Plaza Drive McMurray, PA Washington County 140 Pennsylvania Avenue Sunbury, PA Northumberland County 25 East Park Avenue Suite 8 DuBois, PA Clearfield County 25 Rothermel Drive Suite A Yeagertown, PA Mifflin County 3020 Penn Avenue First Floor West Lawn, PA Berks County North Main Street Carbondale, PA Adler Place Bethlehem, PA Northampton County 449 Lincoln Way East Chambersburg, PA Franklin County 615 Howard Avenue Suite 216 Altoona, PA Blair County 651 Albright Avenue York, PA York County 703 South Elmer Avenue Suite # 115 Sayre, PA Bradford County One Norwegian Plaza Suite 200 Pottsville, PA Schuylkill County Page 12 of 60

13 Page 13 of 60 Drug & Alcohol Buprenorphine Treatment Carbon Monroe Pike Drug & Alcohol Commission, Inc Choices Steven R. Kafrissen, MD Kafrissen, Steven, M.D. 428 South Seventh Street Suite 1 Lehighton, PA Carbon County 562 Wyoming Valley Kingston, PA Wyoming Avenue Kingston, PA Page 13 of 60

14 Page 14 of 60 Drug & Alcohol Case Management Carbon Monroe Pike Drug & Alcohol Commission, Inc Choices Lackawanna/Susquehanna Office of Drug and Alcohol Luzerne-Wyoming Counties D&A Program Wyoming Valley Alcohol and Drug Services, Inc Wyoming Valley Alcohol and Drug Services, Inc South Seventh Street Suite 1 Lehighton, PA Carbon County 307 Laird Street (Rear Entrance) Wilkes-Barre, PA Linden Street Floor 5 20 North Pennsylvania Avenue Penn Place Building, Suite 215 Wilkes-Barre, PA North Main Street Wilkes-Barre, PA South Main Street Pittston, PA Page 14 of 60

15 Page 15 of 60 Drug & Alcohol Halfway House Catholic Charities Clem-Mar House, Inc Clem-Mar House, Inc Foundation Healthcare, LLC Gate House for Men/Women, The Gate House for Men/Women, The Gateway Rehabilitation Center Gateway Rehabilitation Center Gaudenzia, Inc Good Friends, Inc Harwood House James A. Casey House, LLC Libertae, Inc Pyramid Healthcare, Inc Pyramid Healthcare, Inc Treatment Trends, Inc White Deer Run, Inc White Deer Run, Inc Willow Road Suite B Harrisburg, PA Dauphin County Main Street Edwardsville, PA Church Street Dallas, PA Cedar Avenue Scranton, PA West Main Street Mountville, PA Lancaster County 649 East Main Street Lititz, PA Lancaster County 100 Moffett Run Road Aliquippa, PA Beaver County Seventh Avenue Third Floor Beaver Falls, PA Beaver County 91 Broad Street Ashland, PA Schuylkill County 868 West Bridge Street P.O. Box 165 Morrisville, PA Bucks County 9200 West Chester Pike Upper Darby, PA Delaware County 199 South Main Street Wilkes Barre, PA Bensalem Boulevard Bensalem, PA Bucks County South Eagle Valley Road Tyrone, PA Blair County 830 Sixth Avenue Altoona, PA Blair County North Eighth Street Allentown, PA Lehigh County 538 Main Street Johnstown, PA Cambria County 624 Broad Street Johnstown, PA Cambria County Page 15 of 60

16 Page 16 of 60 Drug & Alcohol Inpatient Detox Eagleville Hospital Valley Forge Medical Center & Hospital, Inc Eagleville Road Eagleville, PA Montgomery County 1033 West Germantown Pike Norristown, PA Montgomery County Page 16 of 60

17 Page 17 of 60 Drug & Alcohol Inpatient Rehab Eagleville Hospital Valley Forge Medical Center & Hospital, Inc Eagleville Road Eagleville, PA Montgomery County 1033 West Germantown Pike Norristown, PA Montgomery County Page 17 of 60

18 Page 18 of 60 Drug & Alcohol Intensive Outpatient A Better Today, Inc A Better Today, Inc A Better Today, Inc A Better Today, Inc Alcoholism & Drug Services of Lower Carbon Monroe Pike Drug & Alcohol Commission, Inc Catholic Social Services, Inc Choices Drug and Alcohol Treatment Services, Inc Lourdesmont Good Shepherd Youth & Family Services Marworth Trehab Center, Inc., The Trehab Center, Inc., The Wyoming Valley Alcohol and Drug Services, Inc Warren Street Tunkhannock, PA Wyoming County 1339 North Main Avenue Scranton, PA South Ninth Street Stroudsburg, PA Monroe County 8 West Broad Street Hazleton, PA West Broad Street 2nd Floor Hazleton, PA South Seventh Street Suite 1 Lehighton, PA Carbon County 33 East Northampton Street Wilkes Barre, PA Wyoming Valley Kingston, PA Wyoming Avenue 1327 Wyoming Avenue Scranton, PA Lily Lake Road Waverly, PA Main Street Susquehanna, PA Church Street Suite A Montrose, PA North Main Street Wilkes-Barre, PA Page 18 of 60

19 Page 19 of 60 Drug & Alcohol Level of Care Assessment A Better Today, Inc A Better Today, Inc A Better Today, Inc A Better Today, Inc Alcoholism & Drug Services of Lower Carbon Monroe Pike Drug & Alcohol Commission, Inc Catholic Social Services, Inc Choices Drug and Alcohol Treatment Services, Inc Lackawanna/Susquehanna Office of Drug and Alcohol Luzerne-Wyoming Counties D&A Program Marworth Trehab Center, Inc., The Trehab Center, Inc., The Wayne County Human Service Agency Wyoming Valley Alcohol and Drug Services, Inc Wyoming Valley Alcohol and Drug Services, Inc Warren Street Tunkhannock, PA Wyoming County 1339 North Main Avenue Scranton, PA South Ninth Street Stroudsburg, PA Monroe County 8 West Broad Street Hazleton, PA West Broad Street 2nd Floor Hazleton, PA South Seventh Street Suite 1 Lehighton, PA Carbon County 33 East Northampton Street Wilkes Barre, PA Wyoming Valley Kingston, PA Wyoming Avenue 507 Linden Street Floor 5 20 North Pennsylvania Avenue Penn Place Building, Suite 215 Wilkes-Barre, PA Lily Lake Road Waverly, PA Main Street Susquehanna, PA Church Street Suite A Montrose, PA Tenth Street Wayne County D&A Commission Honesdale, PA Wayne County 437 North Main Street Wilkes-Barre, PA South Main Street Pittston, PA Page 19 of 60

20 Page 20 of 60 Drug & Alcohol Methadone Maintenance Choices Habit Opco, Inc Mount Pocono Medical New Directions Treatment Services New Directions Treatment Services Pennsylvania Care, LLC dba Miners Medical Laird Street (Rear Entrance) Wilkes-Barre, PA Monahan Avenue Dunmore, PA Pocono Boulevard Unit# 3 Mt. Pocono, PA Monroe County North Sixth Avenue West Reading, PA Berks County 2442 Brodhead Road Bethlehem, PA Northampton County 43 South Main Street Ashley, PA Page 20 of 60

21 Page 21 of 60 Drug & Alcohol Non-hospital Detox Bowling Green Brandywine, Inc Choices Clear Brook, Inc Eagleville Hospital Fairmount Behavioral Health Systems Firetree, Ltd Gateway Rehabilitation Center Gaudenzia, Inc Marworth Pyramid Healthcare, Inc Pyramid Healthcare, Inc Valley Forge Medical Center & Hospital, Inc White Deer Run, Inc White Deer Run, Inc White Deer Run, Inc White Deer Run, Inc Newark Road P.O. Box 787 Kennett Square, PA Chester County 562 Wyoming Valley Kingston, PA East Northampton Street Wilkes-Barre, PA Eagleville Road Eagleville, PA Montgomery County 561 Fairthorne Avenue Philadelphia, PA Philadelphia County South Centre Street Conewago Pottsville Pottsville, PA Schuylkill County 100 Moffett Run Road Aliquippa, PA Beaver County 2835 North Front Street Harrisburg, PA Dauphin County Lily Lake Road Waverly, PA Plank Road P.O. Box 967 Duncansville, PA Blair County 306 Penn Avenue Wilkinsburg, PA Allegheny County 1033 West Germantown Pike Norristown, PA Montgomery County 202 Cove Forge Road Williamsburg, PA Blair County 3030 Chestnut Street Lebanon, PA Lebanon County 360 White Deer Run Road P.O. Box 97 Allenwood, PA Union County North West End Avenue Lancaster, PA Lancaster County Page 21 of 60

22 Page 22 of 60 Drug & Alcohol Non-hospital Rehab 3B Bowling Green Brandywine, Inc Choices Clear Brook, Inc Clear Brook, Inc Eagleville Hospital Fairmount Behavioral Health Systems Firetree, Ltd Firetree, Ltd Firetree, Ltd Gateway Rehabilitation Center Gaudenzia, Inc Marworth Pyramid Healthcare, Inc Pyramid Healthcare, Inc Pyramid Healthcare, Inc Pyramid Healthcare, Inc Valley Forge Medical Center & Hospital, Inc White Deer Run, Inc White Deer Run, Inc White Deer Run, Inc White Deer Run, Inc White Deer Run, Inc Newark Road P.O. Box 787 Kennett Square, PA Chester County 562 Wyoming Valley Kingston, PA East Northampton Street Wilkes-Barre, PA Bethel Hill Road Shickshinny, PA Eagleville Road Eagleville, PA Montgomery County 561 Fairthorne Avenue Philadelphia, PA Philadelphia County Route 522 Conewago Snyder Beavertown, PA Snyder County South Centre Street Conewago Pottsville Pottsville, PA Schuylkill County 424 Nye Road Conewago Place Hummelstown, PA Dauphin County 100 Moffett Run Road Aliquippa, PA Beaver County 2835 North Front Street Harrisburg, PA Dauphin County Lily Lake Road Waverly, PA Plank Road P.O. Box 967 Duncansville, PA Blair County 2705 Old Bethlehem Pike Quakertown, PA Bucks County 306 Penn Avenue Wilkinsburg, PA Allegheny County 3893 West Main Street Belleville, PA Mifflin County 1033 West Germantown Pike Norristown, PA Montgomery County 202 Cove Forge Road Williamsburg, PA Blair County 3030 Chestnut Street Lebanon, PA Lebanon County 360 White Deer Run Road P.O. Box 97 Allenwood, PA Union County North West End Avenue Lancaster, PA Lancaster County 8284 Leaser Road Kempton, PA Lehigh County Page 22 of 60

23 Page 23 of 60 Drug & Alcohol Non-hospital Rehab 3C Bowling Green Brandywine, Inc Clear Brook, Inc Colonial House, Inc Cornell Abraxas Group, Inc Drug and Alcohol Rehabilitation Services, Inc Eagleville Hospital Firetree, Ltd Firetree, Ltd Gateway Rehabilitation Center Gaudenzia, Inc Gaudenzia, Inc Gaudenzia, Inc Gaudenzia, Inc Gaudenzia, Inc Libertae, Inc Pyramid Healthcare, Inc Pyramid Healthcare, Inc Pyramid Healthcare, Inc Pyramid Healthcare, Inc Samara House Treatment Trends, Inc Valley Forge Medical Center & Hospital, Inc Newark Road P.O. Box 787 Kennett Square, PA Chester County 890 Bethel Hill Road Shickshinny, PA Woodberry Road York, PA York County Blue Jay Village, Forest Road P.O. Box 59 Marienville, PA Forest County 1290 Prospect Road Columbia, PA Lancaster County 100 Eagleville Road Eagleville, PA Montgomery County Route 522 Conewago Snyder Beavertown, PA Snyder County South Centre Street Conewago Pottsville Pottsville, PA Schuylkill County 100 Moffett Run Road Aliquippa, PA Beaver County 1030 South Concord Road West Chester, PA Chester County 124 Azalea Drive Building #21 Harrisburg, PA Dauphin County 208 East King Street Lancaster, PA Lancaster County 3740 Chambers Hill Road Harrisburg, PA Dauphin County 95 Broad Street Ashland, PA Schuylkill County 5245 Bensalem Boulevard Bensalem, PA Bucks County 1894 Plank Road P.O. Box 967 Duncansville, PA Blair County 2705 Old Bethlehem Pike Quakertown, PA Bucks County 3893 West Main Street Belleville, PA Mifflin County 4447 Gibsonia Road Gibsonia, PA Allegheny County 423 East Lincoln Highway Coatesville, PA Chester County South Sixth Street Allentown, PA Lehigh County 1033 West Germantown Pike Norristown, PA Montgomery County Page 23 of 60

24 Page 24 of 60 Drug & Alcohol Outpatient A Better Today, Inc A Better Today, Inc A Better Today, Inc A Better Today, Inc Alcoholism & Drug Services of Lower Carbon Monroe Pike Drug & Alcohol Commission, Inc Catholic Social Services, Inc Children's Service Center of Wyoming Valley, Inc Choices Drug and Alcohol Treatment Services, Inc Lighthouse Counseling Associates Lourdesmont Good Shepherd Youth & Family Services Marworth New Directions Treatment Services New Directions Treatment Services PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing PA Treatment & Healing Warren Street Tunkhannock, PA Wyoming County 1339 North Main Avenue Scranton, PA South Ninth Street Stroudsburg, PA Monroe County 8 West Broad Street Hazleton, PA West Broad Street 2nd Floor Hazleton, PA South Seventh Street Suite 1 Lehighton, PA Carbon County 33 East Northampton Street Wilkes Barre, PA South Franklin Street Wilkes-Barre, PA Wyoming Valley Kingston, PA Wyoming Avenue 812 South Main Street P.O. Box 35 Taylor, PA Wyoming Avenue Scranton, PA Lily Lake Road Waverly, PA North Sixth Avenue West Reading, PA Berks County 2442 Brodhead Road Bethlehem, PA Northampton County 1400 Fox Hill Road State College, PA Centre County 149 Sawmill Court East Stroudsburg, PA Monroe County 1536 Catherine Street Williamsport, PA Lycoming County 1855 Fair Avenue Honesdale, PA Wayne County 200 Montour Boulevard Suite 1 Bloomsburg, PA Columbia County 2400 Stafford Avenue Business Park, Flex Building #1 - # 400 Scranton, PA North Fourth Street 3rd Ward Professional Building - 2nd Floor Lehighton, PA Carbon County Lower Market Street Milton, PA Northumberland County 96 Ellsworth Drive P.O. Box 310 South Montrose, PA Page 24 of 60

25 Page 25 of 60 Drug & Alcohol Outpatient (continued) Pyramid Healthcare, Inc Trehab Center, Inc., The Trehab Center, Inc., The UPMC Western Psychiatric Institute and Clinic Wyoming Valley Alcohol and Drug Services, Inc Wyoming Valley Alcohol and Drug Services, Inc Sellers Drive Altoona, PA Blair County 1224 Main Street Susquehanna, PA Church Street Suite A Montrose, PA Centre Avenue Pittsburgh, PA Allegheny County 437 North Main Street Wilkes-Barre, PA South Main Street Pittston, PA Page 25 of 60

26 Page 26 of 60 Drug & Alcohol Partial Hospitalization A Better Today, Inc A Better Today, Inc A Better Today, Inc A Better Today, Inc Alcoholism & Drug Services of Lower Choices Drug and Alcohol Treatment Services, Inc Marworth Wyoming Valley Alcohol and Drug Services, Inc Warren Street Tunkhannock, PA Wyoming County 1339 North Main Avenue Scranton, PA South Ninth Street Stroudsburg, PA Monroe County 8 West Broad Street Hazleton, PA West Broad Street 2nd Floor Hazleton, PA Wyoming Valley Kingston, PA Wyoming Avenue Lily Lake Road Waverly, PA North Main Street Wilkes-Barre, PA Page 26 of 60

27 Page 27 of 60 Electroconvulsive Therapy - Inpatient Community Medical Center Geisinger Medical Center Moses Taylor Hospital UPMC Western Psychiatric Institute and Clinic Mulberry Street Scranton, PA North Academy Avenue Danville, PA Montour County 700 Quincy Avenue Scranton, PA O'Hara Street Pittsburgh, PA Allegheny County Page 27 of 60

28 Page 28 of 60 Electroconvulsive Therapy - Outpatient Community Medical Center Geisinger Medical Center Moses Taylor Hospital Mulberry Street Scranton, PA North Academy Avenue Danville, PA Montour County 700 Quincy Avenue Scranton, PA Page 28 of 60

29 Page 29 of 60 Family-based Mental Health Services Children's Service Center of Wyoming Valley, Inc Lourdesmont Good Shepherd Youth & Family Services Scranton Counseling Center South Franklin Street Wilkes-Barre, PA Wyoming Avenue Scranton, PA State Route 706 Suite 1 and 2 Montrose, PA North Main Street Carbondale, PA Adams Avenue Page 29 of 60

30 Page 30 of 60 General Hospital - Lab Services Community Medical Center Geisinger - Bloomsburg Hospital Geisinger Medical Center Gnaden Huetten Memorial Hospital Moses Taylor Hospital Sunbury Community Hospital UPMC Western Psychiatric Institute and Clinic Valley Forge Medical Center & Hospital, Inc Mulberry Street Scranton, PA East Fair Street Bloomsburg, PA Columbia County 100 North Academy Avenue Danville, PA Montour County 211 North Twelfth Street Lehighton, PA Carbon County 700 Quincy Avenue Scranton, PA North Eleventh Street Sunbury, PA Northumberland County 3811 O'Hara Street Pittsburgh, PA Allegheny County 1033 West Germantown Pike Norristown, PA Montgomery County Page 30 of 60

31 Page 31 of 60 Inpatient Mental Health Brooke Glen Behavioral Hospital Clarion Psychiatric Center Community Medical Center Devereux PA - Childrens Behavioral Health Services Eagleville Hospital Fairmount Behavioral Health Systems First Hospital Wyoming Valley Friends Hospital Geisinger - Bloomsburg Hospital Geisinger Medical Center Gnaden Huetten Memorial Hospital Haven Behavioral Hospital of Eastern Pennsylvania Horsham Clinic KidsPeace Hospital, Inc Meadows Psychiatric Center, The Moses Taylor Hospital Philhaven Sunbury Community Hospital UHS of Doylestown dba Foundations Behavioral Health UPMC Western Psychiatric Institute and Clinic Lafayette Avenue Fort Washington, PA Montgomery County Two Hospital Drive Clarion, PA Clarion County 1822 Mulberry Street Scranton, PA Sugartown Road P.O. Box 275 Malvern, PA Chester County 100 Eagleville Road Eagleville, PA Montgomery County 561 Fairthorne Avenue Philadelphia, PA Philadelphia County 562 Wyoming Avenue Kingston, PA Roosevelt Boulevard Philadelphia, PA Philadelphia County 549 East Fair Street Bloomsburg, PA Columbia County 100 North Academy Avenue Danville, PA Montour County 211 North Twelfth Street Lehighton, PA Carbon County 145 North 6th Street Reading, PA Berks County 722 East Butler Pike Ambler, PA Montgomery County 5300 KidsPeace Drive Orefield, PA Lehigh County 132 The Meadows Drive Centre Hall, PA Centre County 700 Quincy Avenue Scranton, PA South Butler Road P.O. Box 550 Mt. Gretna, PA Lebanon County 350 North Eleventh Street Sunbury, PA Northumberland County 833 East Butler Avenue Doylestown, PA Bucks County 3811 O'Hara Street Pittsburgh, PA Allegheny County Page 31 of 60

32 Page 32 of 60 Inpatient Mental Health Sub-acute First Hospital Wyoming Valley Wyoming Avenue Kingston, PA Page 32 of 60

33 Page 33 of 60 Intensive Case Management Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Lourdesmont Good Shepherd Youth & Family Services Scranton Counseling Center South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Wyoming Avenue Scranton, PA State Route 706 Suite 1 and 2 Montrose, PA North Main Street Carbondale, PA West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Adams Avenue Page 33 of 60

34 Page 34 of 60 Mental Health Crisis - Mobile Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Scranton Counseling Center South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Bridge Street Tunkhannock, PA Wyoming County State Route 706 Suite 1 and 2 Montrose, PA North Main Street Carbondale, PA Prospect Street Nanticoke, PA West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Adams Avenue Page 34 of 60

35 Page 35 of 60 Mental Health Crisis - Residential Community Counseling Services of NE Pennsylvania North River Street Wilkes-Barre, PA Page 35 of 60

36 Page 36 of 60 Mental Health Crisis - Telephone Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Scranton Counseling Center South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Bridge Street Tunkhannock, PA Wyoming County State Route 706 Suite 1 and 2 Montrose, PA North Main Street Carbondale, PA Prospect Street Nanticoke, PA West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Adams Avenue Page 36 of 60

37 Page 37 of 60 Mental Health Crisis - Walk-in Children's Service Center of Wyoming Valley, Inc Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Scranton Counseling Center South Franklin Street Wilkes-Barre, PA South Pennsylvania Avenue Wilkes-Barre, PA Bridge Street Tunkhannock, PA Wyoming County State Route 706 Suite 1 and 2 Montrose, PA North Main Street Carbondale, PA Prospect Street Nanticoke, PA West Washington Street Nanticoke, PA East Broad Street Hazleton, PA Adams Avenue Page 37 of 60

38 Page 38 of 60 Mental Health Outpatient Aaron Center, Inc., The Aaron Center, Inc., The Aaron Center, Inc., The Adamec, Susan, L.S.W Advanced Community Service Associates Autism Behavioral Services, Inc LaJeunesse, Charles, Ph.D. Barber, Sheila, Ph.D Bisel, Charmarie, L.S.W B-K Health Center, Inc., d/b/a NEPA Community Health Care B-K Health Center, Inc., d/b/a NEPA Community Health Care Brooke E. Egbert, PsyD, LLC Egbert, Brooke, Psy.D. Brooke E. Egbert, PsyD, LLC Egbert, Brooke, Psy.D. Brooker, Deborah, Ph.D Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc Children's Service Center of Wyoming Valley, Inc CJA Counseling Anuszewski, Chad, L.P.C Turnpike Street Susquehanna, PA Spruce Street The Bank Towers Building 851 Commerce Boulevard Suite 107 Dickson City, PA Main Street P.O. Box 894 New Milford, PA Clay Avenue Suite 2 Dunmore, PA Wyoming Avenue Exeter, PA Cherry Lane Road East Stroudsburg, PA Monroe County 693 Main Street P.O. Box 894 New Milford, PA Erie Boulevard Susquehanna, PA State Route 11 Hallstead, PA Twin Stacks Drive Dallas, PA North River Street Suite 206 Plains, PA Main Street Suite 5 Vestal, NY Broome County 1 South Sherman Street Murray Heaights Elementary School Wilkes-Barre, PA New Street Pittston Area Middle School/Intermdediate Center Pittston, PA West Tioga Street Tunkhannock, PA Wyoming County 301 Old River Road Kistler Elementary School Wilkes-Barre, PA South Franklin Street Wilkes-Barre, PA East State Street Larksville, PA North Washington Street Flood Elementary School Wilkes-Barre, PA Jones Street Dodson Elementary School Wilkes-Barre, PA Scranton Carbondale Highway Eynon, PA Page 38 of 60

39 Page 39 of 60 Mental Health Outpatient (continued) CJA Counseling Anuszewski, Chad, L.P.C. Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Community Counseling Services of NE Pennsylvania Confidential Counseling Services Brust, Paula, M.A., LPC Cornell, Sara, Psy.D Cornerstone Coordinated Health Care, LLC Cornerstone Counseling & Consulting Specialists Day, Paulette, M.A. Egbert, Brooke, Psy.D. Gray, Marie, Ph.D., L.P.C. Cronin, Linda, L.C.S.W Cronin, Linda, L.C.S.W Cynthia Edwards-Hawver Edwards-Hawver, Cynthia, Psy.D. Dougherty, Thomas, L.P.C Dougherty, Thomas, L.P.C Durso, Mary, M.A Early Psychiatric and Counseling PC Rahman, Shafiq, M.D. Early Psychiatric and Counseling PC Rahman, Shafiq, M.D. Early Psychiatric and Counseling PC Rahman, Shafiq, M.D. Early Psychiatric and Counseling PC Rahman, Shafiq, M.D. Elizabeth A. Ciaravino, PhD Ciaravino, Elizabeth, Ph.D. Family Enrichment Center, P.C Matthews, Michael, Ph.D. Family Service Association of Northeastern Pennsylvania Delio, Joanna, L.C.S.W. Freeman, Amy, M.S.W., L.C.S.W. Hoover Mericle, Catherine, M.S.W., L.C.S.W. Luvender, Sarah, L.C.S.W. Scalise-Warnitsky, Marietta, L.C.S.W. Forensic Counseling Associates, LLC Bertanzetti, Lori, L.C.S.W. Burkit, William, L.P.C. Fratzola, Roberta, L.P.C. Haupt, Carol, L.P.C. 241 B. Main Street Blakely, PA South Pennsylvania Avenue Wilkes-Barre, PA Wyoming Avenue Kingston, PA Bridge Street Tunkhannock, PA Wyoming County 2200 Ash Street Scranton, PA A Church Street Suite 218 Hazle Township, PA West Frack Street Frackville, PA Schuylkill County 1172 Twin Stacks Drive Dallas, PA Public Avenue Montrose, PA Main Street Binghamton, NY Broome County 400 South State Street Clarks Summit, PA Market Street Suite 3 Kingston, PA Penn Avenue 359 South Mountain Boulevard Suite C2 Mountain Top, PA Market Street Suite 35 Bloomsburg, PA Columbia County 116 North Fifth Street Hazleton, PA North Main Street Shavertown, PA South Mountain Boulevard Mountaintop, PA Spruce Street 7th Floor 541 Wyoming Avenue Scranton, PA West Market Street Wilkes Barre, PA Pocono Boulevard Mt. Pocono, PA Monroe County Page 39 of 60

40 Page 40 of 60 Mental Health Outpatient (continued) Forensic Counseling Associates, LLC Bertanzetti, Lori, L.C.S.W. Burkit, William, L.P.C. Fratzola, Roberta, L.P.C. Haupt, Carol, L.P.C. Fran Angelella, Psy.D Angelella, Francis, Psy.D. Fremont, Jeffrey, Ph.D Friendship House Friendship House Geisinger Clinic Geisinger Clinic Geisinger Clinic Geisinger Clinic George Junior Republic in Pennsylvania Hoffman, Diana, M.A Hoffman, Diana, M.A Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D. 538 Spruce Street Suite Wyoming Avenue Exeter, PA Wyoming Avenue Forty-Fort, PA Maple Street Scranton, PA Delaware Street P.O. Box 1008 Honesdale, PA Wayne County 100 North Academy Avenue Danville, PA Montour County 120 Hamm Drive Lewisburg, PA Union County 201 Roosevelt Avenue Selinsgrove, PA Snyder County 529 Terry Reiley Way Pottsville, PA Schuylkill County 233 George Junior Road P.O. Box 1058 Grove City, PA Mercer County 299 Main Street Suite 103 Olyphant, PA South Irving Avenue Scranton, PA East Market Street Pressley Ridge York, PA York County 20 Depot Street Suite 103 Lewistown, PA Mifflin County 2030 Thistle Drive Suite 205 Spring Grove, PA York County 25 Rothermel Drive, Suite A NHS Human Services Yeagertown, PA Mifflin County 2880 Pottsville-Minersville Highway, Suite 150 New Story Minersville, PA Schuylkill County 353 Rear Market Street Sunbury, PA Northumberland County Page 40 of 60

41 Page 41 of 60 Mental Health Outpatient (continued) Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D Bloszinsky, Scott, Psy.D. Fernandez, Jennifer, Ph.D. Smith, Hugh, Ph.D. Integrative Counseling Services PC Kerr, Alyse, M.S., L.P.C. Jewish Family Service of Northeastern Pennsylvania Abdo, Sheila, L.C.S.W. Bushwick, Marguerite, L.C.S.W. Dunford, Peter, L.S.W. Friedman, Nicole, L.S.W. Minkoff, Don, L.C.S.W. Jewish Family Service of Northeastern Pennsylvania Abdo, Sheila, L.C.S.W. Bushwick, Marguerite, L.C.S.W. Minkoff, Don, L.C.S.W. John G. Kuna PsyD & Associates LLC Kuna, John, Psy.D. John G. Kuna PsyD & Associates LLC Kuna, John, Psy.D. John G. Kuna PsyD & Associates LLC Kuna, John, Psy.D. Lighthouse Counseling Associates Costello, Jacqueline, L.P.C. Luzerne Intermediate Unit Marcy Lynn Duffy Duffy, Marcy, L.P.C. Mark K. Sowcik, PhD Betts, Jennifer, Psy.D. Richards, Maria, Psy.D. Scott, William, M.S. Sowcik, Mark, Ph.D. Mary Martin Counseling Services Martin, Mary, L.C.S.W. Matthew Berger, M.D., PC Albrecht, Karlene, L.P.C. Gordon, Tina, M.A., L.M.F.T. Kovacs, Theresa, Psy.D. Kravchick, Martin, L.C.S.W. Krupa, Anne, L.C.S.W. Lopes, Joseph, L.C.S.W. Mines, Kimberly, L.C.S.W. Nardell, Kristie, M.D. Nataupsky, Kelsey, M.A., L.M.F.T. O'Donnell, Donna, M.A., LPC Oravec, Andrea, L.C.S.W. Pancoast, Priscilla, L.C.S.W. Rogan, Joan, L.C.S.W. Melissa A. Cottone MA LPC BCBA LLC Cottone, Melissa, L.P.C. Muto, Nicholas, M.S Ryan Run Road, Suite 201 New Story York, PA York County 619 Mahantongo Street NHS Human Services Pottsville, PA Schuylkill County 300 Mulberry Street Suite Jefferson Avenue Suite 204 Scranton, PA Main Street Stroudsburg, PA Monroe County 1011 Pennsylvania Avenue Matamoras, PA Pike County 112 Warren Street Tunkhannock, PA Wyoming County 4101 Birney Avenue Moosic, PA South Main Street P.O. Box 35 Taylor, PA Franklin Avenue Tunkhannock Area Middle School Tunkhannock, PA Wyoming County 1509 North Main Avenue Scranton, PA Main Street Luzerne, PA Third Avenue Suite 308 Kingston, PA Montage Mountain Road Moosic, PA Spruce Street Suite Main Street Suite 101 Peckville, PA Page 41 of 60

42 Page 42 of 60 Mental Health Outpatient (continued) New Directions Treatment Services New Directions Treatment Services New Directions Treatment Services Nicholas J. Telincho Jr Telincho Jr, Nicholas, L.C.S.W. Nicholas J. Telincho Jr Telincho Jr, Nicholas, L.C.S.W. Nicholas J. Telincho Jr Telincho Jr, Nicholas, L.C.S.W. Nicholas J. Telincho Jr Telincho Jr, Nicholas, L.C.S.W North Sixth Avenue West Reading, PA Berks County 2456 Brodhead Road Bethlehem, PA Northampton County 4 Park Plaza Suite 102 Wyomissing, PA Berks County 100 Susquehanna Street Forest City School Forest City, PA State Route 706 Suite 1 and 2 Montrose, PA Northwestern Drive Coal Township, PA Northumberland County North Main Street Carbondale, PA Turnpike Street Susquehanna, PA Main Street Suite 201 Honesdale, PA Wayne County Brixx Building Fourth Floor Treatment Court Route 11 Blue Ridge School New Milford, PA RR 1 Box 339 Mountain View High School Kingsley, PA North Fifth Street Hazelton, PA North Main Street Shavertown, PA Chase Street West Pittston, PA A Old Berwick Road Bloomsburg, PA Columbia County 121 Prospect Street Nanticoke, PA West Washington Street Nanticoke, PA North 23rd Street Hazleton Area High School Hazleton, PA Sunset Lake Road Hunlock Elementary School Hunlock Township, PA East Broad Street Nanticoke, PA Thome Hill Northwest Area Jr./Sr. High School Union Township, PA Mill Street Terrace Elementary/Middle School Hazleton, PA Page 42 of 60