Healthcare Provider Details

I. General information

NPI: 1104928266
Provider Name (Legal Business Name): RENATA ELLEN HARLAND PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 PEACH ST STE 105
ERIE PA
16501-2120
US

IV. Provider business mailing address

1611 PEACH ST STE 105
ERIE PA
16501-2120
US

V. Phone/Fax

Practice location:
  • Phone: 814-440-7909
  • Fax: 814-240-6886
Mailing address:
  • Phone: 814-440-7909
  • Fax: 814-240-6886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS016407
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: