=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629398672
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALING HEARTS PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2010
-----------------------------------------------------
Last Update Date | 06/01/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3255 WEST 26TH STREET
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-836-8888
-----------------------------------------------------
Fax | 814-836-8880
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3255 WEST 26TH STREET
-----------------------------------------------------
City | ERIE
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16506-2507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-836-8888
-----------------------------------------------------
Fax | 814-836-8880
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHIATRIST
-----------------------------------------------------
Name | DR. BELINDA ANN STILLMAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 814-836-8888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | B57435147
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 05013137
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------