1134564297 NPI number — MRS. KELI DAWN DE CARLO LPC, NCC

Table of content: MRS. KELI DAWN DE CARLO LPC, NCC (NPI 1134564297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134564297 NPI number — MRS. KELI DAWN DE CARLO LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE CARLO
Provider First Name:
KELI
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134564297
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 LIBERTY STREET
Provider Second Line Business Mailing Address:
SMITHFIELD ELEMENTARY SCHOOL
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-569-9570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 S. PITTSBURGH STREET
Provider Second Line Business Practice Location Address:
CONNELLSVILLE COUNSELING AND PSYCHOLOGICAL SERVICES
Provider Business Practice Location Address City Name:
CONNELLSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-626-8420
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC006874 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)