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General NPI Number Information
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NPI Number | 1477112118
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Entity Type | Organization
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Legal Business Name | KRISTA MANCARELLA LLC
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Dates
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Enumeration Date | 06/06/2019
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Last Update Date | 06/06/2019
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Provider Practice Location Address
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Address Line | 6198 BUTLER PIKE STE 125
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City | BLUE BELL
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State | PA
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Zip | 19422-2611
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Country | US
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Telephone | 215-300-1375
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 226
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City | NORTH GRANBY
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State | CT
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Zip | 06060-0226
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Country | US
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Telephone | 860-431-0622
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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. KRISA MANCARELLA
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Credential | PSY.D.
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Telephone | 860-431-0622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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