Provider Demographics
NPI:1376153940
Name:NAMI ERIE COUNTY PA
Entity Type:Organization
Organization Name:NAMI ERIE COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLIVOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-456-1773
Mailing Address - Street 1:1611 PEACH ST STE 218
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-2121
Mailing Address - Country:US
Mailing Address - Phone:814-456-1773
Mailing Address - Fax:
Practice Address - Street 1:1611 PEACH ST STE 218
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-2121
Practice Address - Country:US
Practice Address - Phone:814-456-1773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)