Healthcare Provider Details

I. General information

NPI: 1861425043
Provider Name (Legal Business Name): RICHARD A. SEKULA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 W 26TH ST
ERIE PA
16506-3261
US

IV. Provider business mailing address

3250 W LAKE RD SUITE 2
ERIE PA
16505-3691
US

V. Phone/Fax

Practice location:
  • Phone: 814-397-6077
  • Fax:
Mailing address:
  • Phone: 814-790-4567
  • Fax: 814-295-4074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS0053262
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005326L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: