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NPI 1588899264

NPI 1588899264 : CRAIG NEVIN PISO PH.D. : LARKSVILLE, PA

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General NPI Number Information
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    NPI Number           |    1588899264
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    Entity Type          |    Individual 
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    Provider Name        |    CRAIG NEVIN PISO PH.D.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    05/24/2009
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    Last Update Date     |    05/24/2009
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Provider Practice Location Address
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    Address Line         |    312 E ORIOLE DR 
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    City                 |    LARKSVILLE
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    State                |    PA
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    Zip                  |    18704-1617
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    Country              |    US
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    Telephone            |    570-239-3114
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    312 E ORIOLE DR 
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    City                 |    LARKSVILLE
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    State                |    PA
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    Zip                  |    18704-1617
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    Country              |    US
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    Telephone            |    570-239-3114
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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        |    103T00000X
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    Taxonomy Name        |    Psychologist
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    License Number       |    004245
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    License Number State |    PA
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