Basic Information
| Provider Information | |||||||||
| NPI: | 1609984343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST ANTHONYS POINT INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3679 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161483411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Practice Location | |||||||||
| Address1: | 3679 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | HERMITAGE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161483411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249820414 | ||||||||
| FaxNumber: | 7249824407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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| AuthorizedOfficialLastName: | MIKITA | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PSYCHOLOGIST OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7249820414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW128655 | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | 101YP2500X | PC006662 | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 103TC1900X | PS008073L | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling | 103TB0200X | PS008073L | PA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103K00000X | PC005176 | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 103T00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 0018158430001 | 05 | PA | MEDICAID | 001397685 | 01 | PA | HIGHMARK BCBS | OTHER |