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Individual
JACK WARREN ITO
Active
Individual
JACK WARREN ITO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS008530L
PA
103TC0700X
Clinical Psychologist
Primary
PS008530L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016536380004
—
PA
01
—
163751
VALUE BEHAVIORAL HEALTH
PA
01
—
959098
HIGHMARK PROVIDER NUMBER
PA
01
—
A771081
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
01/11/2006
Last updated
11/01/2007
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