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General NPI Number Information
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NPI Number | 1902179989
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Entity Type | Organization
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Legal Business Name | MERION CREEK MENTAL HEALTH SERVICES, INC.
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Dates
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Enumeration Date | 02/21/2012
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Last Update Date | 02/21/2012
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Provider Practice Location Address
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Address Line | 1 CENTER SQ SUITE 208
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City | HANOVER
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State | PA
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Zip | 17331-3013
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Country | US
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Telephone | 855-637-4662
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CENTER SQ SUITE 208
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City | HANOVER
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State | PA
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Zip | 17331-3013
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Country | US
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Telephone | 855-637-4662
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. MICHAEL PATRICK CAIAZZO
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Credential | PSY.D.
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Telephone | 855-637-4662
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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 | PS017064
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License Number State | PA
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