Provider Demographics
NPI:1154627560
Name:SUNRISE PSYCHOLOGICAL SERVICES LLC
Entity Type:Organization
Organization Name:SUNRISE PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:POZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-469-4026
Mailing Address - Street 1:320 MANADA BOTTOM RD
Mailing Address - Street 2:
Mailing Address - City:GRANTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17028-9016
Mailing Address - Country:US
Mailing Address - Phone:717-469-4026
Mailing Address - Fax:
Practice Address - Street 1:5922 LINGLESTOWN RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1149
Practice Address - Country:US
Practice Address - Phone:717-469-4026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016220103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty