Organization
CENTERVILLE CLINICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY R NICCOLAI (EXECUTIVE DIRECTOR)
(724) 632-6801
Entity
Organization
Contact information
Practice address
CALIFORNIA ELEMENTARY SCHOOL, 40 TROJAN WAY, COAL CENTER, PA 15423-1059
(724) 785-5800
Mailing address
CENTERVILLE CLINICS INC, 1070 OLD NATIONAL PIKE ROAD, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440027
—
PA
Enumeration date
07/12/2018
Last updated
10/17/2018
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