Healthcare Provider Details

I. General information

NPI: 1609984343
Provider Name (Legal Business Name): ST ANTHONYS POINT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3679 E STATE ST
HERMITAGE PA
16148-3411
US

IV. Provider business mailing address

3679 E STATE ST
HERMITAGE PA
16148-3411
US

V. Phone/Fax

Practice location:
  • Phone: 724-982-0414
  • Fax: 724-982-4407
Mailing address:
  • Phone: 724-982-0414
  • Fax: 724-982-4407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006662
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberPC005176
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS008073L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS008073L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW128655
License Number StatePA

VIII. Authorized Official

Name: DEBORAH J MIKITA
Title or Position: PSYCHOLOGIST OWNER
Credential: MA
Phone: 724-982-0414