Provider Demographics
NPI:1376702266
Name:MARONEY, JERRI L (PHD)
Entity Type:Individual
Prefix:
First Name:JERRI
Middle Name:L
Last Name:MARONEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17102-2147
Mailing Address - Country:US
Mailing Address - Phone:866-829-1154
Mailing Address - Fax:717-221-8006
Practice Address - Street 1:251 WICONISCO ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1136
Practice Address - Country:US
Practice Address - Phone:866-829-1154
Practice Address - Fax:717-221-8006
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016436103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral