Individual
MS. MARIA LEE MODZELEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ED.S.
Contact information
Practice address
1010 BROOKS BAY DR, ERIE, PA 16505-5706
(252) 213-0001
(919) 693-9381
Mailing address
307 BEVERLY DR, ERIE, PA 16505-2205
(814) 823-5645
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
6086854
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6086854
COMMONWEALTH OF PENNSYLVANIA (PDE)
PA
Enumeration date
09/12/2022
Last updated
09/12/2022
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