Provider Demographics
NPI:1659442580
Name:VONMICKWITZ, MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:VONMICKWITZ
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 1:121 W SECOND AVE
Mailing Address - Street 2:EXCELA LATROBE HOSPITAL
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1068
Mailing Address - Country:US
Mailing Address - Phone:724-537-1650
Mailing Address - Fax:724-537-1918
Practice Address - Street 1:121 W SECOND AVE
Practice Address - Street 2:EXCELA LATROBE HOSPITAL
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1068
Practice Address - Country:US
Practice Address - Phone:724-537-1650
Practice Address - Fax:724-537-1918
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002632L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical