Provider Demographics
NPI:1609000710
Name:BILLMYER, ADRIENNE MARIE (BS)
Entity Type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:MARIE
Last Name:BILLMYER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CAMERON ST STE 401
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2424
Mailing Address - Country:US
Mailing Address - Phone:717-236-7357
Mailing Address - Fax:717-236-2204
Practice Address - Street 1:100 N CAMERON ST STE 401
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2424
Practice Address - Country:US
Practice Address - Phone:717-236-7357
Practice Address - Fax:717-236-2204
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
PABH001882103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH001882OtherBEHAVIOR SPECIALIST LICENSE