Provider Demographics
NPI:1134128507
Name:MENTA, CAROLYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:
Last Name:MENTA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 KOLTER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3570
Mailing Address - Country:US
Mailing Address - Phone:724-357-7196
Mailing Address - Fax:724-357-7279
Practice Address - Street 1:850 HOSPITAL RD
Practice Address - Street 2:SUITE 2200, MEDICAL ARTS BLDG
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-464-0270
Practice Address - Fax:724-464-0274
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSO15068103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1364972OtherBS#
054561E4YMedicare ID - Type Unspecified
P50094Medicare UPIN