Provider Demographics
NPI:1003031246
Name:GIACOMELLI, RICHARD ALLEN (MA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALLEN
Last Name:GIACOMELLI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3625
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-0625
Mailing Address - Country:US
Mailing Address - Phone:814-796-6294
Mailing Address - Fax:
Practice Address - Street 1:2820 W 21ST ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-2983
Practice Address - Country:US
Practice Address - Phone:814-882-7650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003775L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist