Healthcare Provider Details

I. General information

NPI: 1689642522
Provider Name (Legal Business Name): DAVID L CHIARELLA PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GYPSY LN
YOUNGSTOWN OH
44504-1315
US

IV. Provider business mailing address

2985 FOSTER DR NE
WARREN OH
44483-5641
US

V. Phone/Fax

Practice location:
  • Phone: 330-884-3167
  • Fax: 330-884-0636
Mailing address:
  • Phone: 330-372-2389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number4187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: