Healthcare Provider Details

I. General information

NPI: 1467676247
Provider Name (Legal Business Name): CYRIL TOWNSEND VELKOFF M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 EAST ST
WILLIAMSPORT PA
17701-6613
US

IV. Provider business mailing address

830 FOGELMAN RD
MUNCY PA
17756-6811
US

V. Phone/Fax

Practice location:
  • Phone: 570-337-3320
  • Fax:
Mailing address:
  • Phone: 570-337-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS005208L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS005208L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: