Provider Demographics
NPI:1871727883
Name:EMPOWER YOUTH, LLC
Entity type:Organization
Organization Name:EMPOWER YOUTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/LEAD COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:PRUETT-SARATAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CCDPD
Authorized Official - Phone:610-742-7782
Mailing Address - Street 1:210 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3101
Mailing Address - Country:US
Mailing Address - Phone:610-565-4360
Mailing Address - Fax:610-565-3076
Practice Address - Street 1:210 W FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3101
Practice Address - Country:US
Practice Address - Phone:610-565-4360
Practice Address - Fax:610-565-3076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004594251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020417300001Medicaid
11767954OtherCAQH