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NPI Code Detail

MEDICARE: MELISSA L HERTRICH PSY.D

MEDICARE: MELISSA L HERTRICH PSY.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC2200XClinical Child & Adolescent PsychologistPS015562PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11884139OTHERPAHIGHMARK BLUE SHIELD

General Provider Information

NPI Number : 1730144619
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELISSA L HERTRICH PSY.D
Provider Business Mailing Address
First Line : 1803 MOUNT ROSE AVE
Second Line : STE B3
City : YORK
State : PA
Zip : 17403-3026
Country : US
Telephone Number : 717-851-1405
Fax Number : 717-851-6349
Provider Business Practice Location Address
First Line : 3550 CONCORD RD
Second Line :
City : YORK
State : PA
Zip : 17402-8626
Country : US
Telephone Number : 717-851-6340
Fax Number : 717-851-6349
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 07/14/2016

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