Provider Demographics
NPI:1467517045
Name:PERSON, DENISE CHERYL (PHD)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:CHERYL
Last Name:PERSON
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 1:925 WEST COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2804
Mailing Address - Country:US
Mailing Address - Phone:814-235-5464
Mailing Address - Fax:
Practice Address - Street 1:925 WEST COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2804
Practice Address - Country:US
Practice Address - Phone:814-235-5464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAPS015264103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017330800001Medicaid
PA1017330800001Medicaid