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

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	:	104 ALDERWOOD DR
Second Line	:
City	:	GREENSBURG
State	:	PA
Zip	:	15601-5479
Country	:	US
Telephone Number	:	724-691-6120
Fax Number	:

Provider Business Practice Location Address
First Line	:	3543 DREHER SHOALS RD
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-7608
Country	:	US
Telephone Number	:	803-977-4170
Fax Number	:

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

Provider Enumeration Date	:	11/20/2025
Last Update Date	:	12/04/2025

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