MEDICARE: MR. CHANSEREY PICH PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	125645	WV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	SP034602	PA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	31217	SC

General Provider Information

NPI Number	:	1598626475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHANSEREY PICH PMHNP-BC

Provider Business Mailing Address
First Line	:	310 CENTRAL CITY PLZ
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 CENTRAL CITY PLZ
Second Line	:
City	:	NEW KENSINGTON
State	:	PA
Zip	:	15068-6441
Country	:	US
Telephone Number	:	878-847-7179
Fax Number	:	878-847-7180

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

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	04/13/2026

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