Provider Demographics
NPI:1619142601
Name:DERICCO, JUDITH NIHILL (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:NIHILL
Last Name:DERICCO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WALNUT BOTTOM RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015-7766
Mailing Address - Country:US
Mailing Address - Phone:717-243-1511
Mailing Address - Fax:717-243-1530
Practice Address - Street 1:1200 WALNUT BOTTOM RD
Practice Address - Street 2:SUITE 311
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-7766
Practice Address - Country:US
Practice Address - Phone:717-243-1511
Practice Address - Fax:717-243-1530
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004711101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional