Provider Demographics
NPI:1386190668
Name:CARRITA, NICOLE I
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:CARRITA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MATCH FACTORY PLACE 3RD
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTE
Mailing Address - State:PA
Mailing Address - Zip Code:16823
Mailing Address - Country:US
Mailing Address - Phone:814-353-3151
Mailing Address - Fax:814-355-2244
Practice Address - Street 1:190 MATCH FACTORY PLACE 3RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTE
Practice Address - State:PA
Practice Address - Zip Code:16823
Practice Address - Country:US
Practice Address - Phone:814-353-3151
Practice Address - Fax:814-355-2244
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health