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General NPI Number Information
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NPI Number | 1154627560
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Entity Type | Organization
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Legal Business Name | SUNRISE PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 02/02/2011
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Last Update Date | 02/02/2011
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Provider Practice Location Address
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Address Line | 5922 LINGLESTOWN RD 1ST FLOOR
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City | HARRISBURG
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State | PA
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Zip | 17112-1149
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Country | US
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Telephone | 717-469-4026
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Fax |
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Provider Business Mailing Address
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Address Line | 320 MANADA BOTTOM RD
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City | GRANTVILLE
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State | PA
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Zip | 17028-9016
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Country | US
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Telephone | 717-469-4026
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. CARLOS FERNANDO POZZI
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Credential | PSY.D.
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Telephone | 717-469-4026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016220
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License Number State | PA
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