| Carolyn I. Vicchiullo, Psy.d., Pc | |
|
2030 Lehigh St Suite 107 Easton PA 18042-3853 | |
| (610) 253-8900 | |
| (610) 253-7062 |
| Full Name | Carolyn I. Vicchiullo, Psy.d., Pc |
|---|---|
| Speciality | Psychologist |
| Location | 2030 Lehigh St, Easton, Pennsylvania |
| Authorized Official Name and Position | Carolyn I. Vicchiullo (PRESIDENT) |
| Authorized Official Contact | 6102538900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carolyn I. Vicchiullo, Psy.d., Pc 2030 Lehigh St Suite 107 Easton PA 18042-3853 Ph: (610) 253-8900 | Carolyn I. Vicchiullo, Psy.d., Pc 2030 Lehigh St Suite 107 Easton PA 18042-3853 Ph: (610) 253-8900 |
| NPI Number | 1235305210 |
|---|---|
| Provider Enumeration Date | 04/30/2008 |
| Last Update Date | 04/30/2008 |
| Medicare PECOS PAC ID | 0446430714 |
|---|---|
| Medicare Enrollment ID | O20110204000137 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235305210 | NPI | - | NPPES |
| 262019000 | Other | PA | MAGELLAN |
| 03183600 | Other | CBC | |
| 1765117 | Other | HIGHMARK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PS015116 (Pennsylvania) | Primary |
| Provider Name | Carolyn I Vicchiullo |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1194798108 PECOS PAC ID: 0042494338 Enrollment ID: I20110412000057 |
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