Provider Demographics
NPI:1275641912
Name:ST MICHAELS HARBOUR INC
Entity Type:Organization
Organization Name:ST MICHAELS HARBOUR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:V
Authorized Official - Last Name:MIKITA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:724-982-0414
Mailing Address - Street 1:PO BOX 840
Mailing Address - Street 2:87 STAMBAUGH AVE STE 5
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146
Mailing Address - Country:US
Mailing Address - Phone:724-982-0414
Mailing Address - Fax:724-982-4407
Practice Address - Street 1:87 STAMBAUGH AVE
Practice Address - Street 2:STE 5
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146
Practice Address - Country:US
Practice Address - Phone:724-982-0414
Practice Address - Fax:724-982-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty