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General NPI Number Information
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NPI Number | 1881921500
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Entity Type | Organization
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Legal Business Name | MIND FLEX LLC
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 254 RADCLIFFE ST 3RD FLOOR
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City | BRISTOL
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State | PA
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Zip | 19007-5014
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Country | US
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Telephone | 610-812-4730
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Fax |
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Provider Business Mailing Address
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Address Line | 254 RADCLIFFE ST 3RD FLOOR
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City | BRISTOL
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State | PA
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Zip | 19007-5014
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Country | US
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Telephone | 610-812-4730
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR/PSYCHOLOGIST
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Name | DR. LEE ANTHONY PICARIELLO
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Credential | PSY.D
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Telephone | 610-812-4571
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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 | PS01634
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License Number State | PA
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