Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS003775L | PA |
Y | 103T00000X | Psychologist | PS003775L | PA |
NPI | 1003031246 |
---|---|
Provider Name | Richard Allen Giacomelli |
First Address | Erie, PA 16508-0625 |
Second Address | Erie, PA 16506-2983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 08/07/2007 |