Provider Demographics
NPI:1609984343
Name:ST ANTHONYS POINT INC
Entity Type:Organization
Organization Name:ST ANTHONYS POINT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MIKITA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:724-982-0414
Mailing Address - Street 1:3679 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3411
Mailing Address - Country:US
Mailing Address - Phone:724-982-0414
Mailing Address - Fax:724-982-4407
Practice Address - Street 1:3679 E STATE ST
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3411
Practice Address - Country:US
Practice Address - Phone:724-982-0414
Practice Address - Fax:724-982-4407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006662101YP2500X
PC005176103K00000X
103T00000X
PAPS008073L103TB0200X, 103TC1900X
PASW128655104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018158430001Medicaid
PA001397685OtherHIGHMARK BCBS