Provider Demographics
NPI:1578177507
Name:PETRUCCELLI, MEREDITH (PHD, NCSP)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:
Last Name:PETRUCCELLI
Suffix:
Gender:F
Credentials:PHD, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 STATION WAY RD STE 2
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9782
Mailing Address - Country:US
Mailing Address - Phone:215-760-0556
Mailing Address - Fax:
Practice Address - Street 1:2 STATION WAY RD STE 2
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9782
Practice Address - Country:US
Practice Address - Phone:215-760-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017201103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool