MEDICARE: MR. THOMAS JOHN CALABRESE LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC001845	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1796053	OTHER	PA	HIGHMARK INS PROVIDER #

General Provider Information

NPI Number	:	1023046117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOHN CALABRESE LPC

Provider Business Mailing Address
First Line	:	1125 ARIS DR
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-1211
Country	:	US
Telephone Number	:	814-838-8878
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 PEACH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-1358
Country	:	US
Telephone Number	:	814-866-0905
Fax Number	:	814-866-0905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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