Organization
CENTERVILLE CLINICS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY NICCOLAI (EXECUTIVE DIRECTOR)
(724) 632-6801
Entity
Organization
Contact information
Practice address
2500 SOUTH MAIN ST EXT., TRINITY SOUTH ELEMENTARY SCHOOL, WASHINGTON, PA 15301
(724) 225-7490
Mailing address
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
01/24/2018
Last updated
01/24/2018
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