Healthcare Provider Details

I. General information

NPI: 1346098407
Provider Name (Legal Business Name): HEATHER COTIGNOLA-PICKENS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER COTIGNOLA

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 BUTLER RD
MOUNT GRETNA PA
17064-6085
US

IV. Provider business mailing address

283 BUTLER RD
MOUNT GRETNA PA
17064-6085
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-8871
  • Fax: 717-279-2778
Mailing address:
  • Phone: 717-273-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020140
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: