Basic Information
| Provider Information | |||||||||
| NPI: | 1275641912 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST MICHAELS HARBOUR INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 840 | ||||||||
| Address2: | 87 STAMBAUGH AVE STE 5 | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Practice Location | |||||||||
| Address1: | 87 STAMBAUGH AVE | ||||||||
| Address2: | STE 5 | ||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 16146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 09/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | MIKITA | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7249820414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.