Healthcare Provider Details

I. General information

NPI: 1710089438
Provider Name (Legal Business Name): LINDA KNIGHTON COLLEVECCHIO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA LEE COLLEVECCHIO PHD

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3995 EAST MARKET STREET
YORK PA
17402
US

IV. Provider business mailing address

3995 EAST MARKET STREET
YORK PA
17402
US

V. Phone/Fax

Practice location:
  • Phone: 717-757-1227
  • Fax: 717-757-1353
Mailing address:
  • Phone: 717-757-1227
  • Fax: 717-757-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006099L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: