| Guiding Light Health Pc | |
|
1315 S Allen St Ste 104 State College PA 16801-5923 | |
| (814) 753-4422 | |
| Not Available |
| Full Name | Guiding Light Health Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1315 S Allen St Ste 104, State College, Pennsylvania |
| Authorized Official Name and Position | Dmitry A Vilensky (PRESIDENT) |
| Authorized Official Contact | 8147534422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Guiding Light Health Pc 1315 S Allen St Ste 104 State College PA 16801-5923 Ph: (814) 753-4422 | Guiding Light Health Pc 1315 S Allen St Ste 104 State College PA 16801-5923 Ph: (814) 753-4422 |
| NPI Number | 1306359914 |
|---|---|
| Provider Enumeration Date | 11/06/2017 |
| Last Update Date | 01/28/2021 |
| Certification Date | 01/28/2021 |
| Medicare PECOS PAC ID | 2466716782 |
|---|---|
| Medicare Enrollment ID | O20180514000493 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306359914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | MD451033 (Pennsylvania) | Primary |
| Provider Name | Dmitry A Vilensky |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548581481 PECOS PAC ID: 4082831672 Enrollment ID: I20140805001289 |
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