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General NPI Number Information
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NPI Number | 1548981103
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Entity Type | Individual
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Provider Name | MARIA LEE MODZELEWSKI ED.S.
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 1010 BROOKS BAY DR
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City | ERIE
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State | PA
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Zip | 16505-5706
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Country | US
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Telephone | 252-213-0001
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Fax | 919-693-9381
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Provider Business Mailing Address
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Address Line | 307 BEVERLY DR
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City | ERIE
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State | PA
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Zip | 16505-2205
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Country | US
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Telephone | 814-823-5645
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 6086854
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License Number State | PA
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