Provider Demographics
NPI:1750301354
Name:CHIARIELLO, DOMENICO (PHD)
Entity Type:Individual
Prefix:DR
First Name:DOMENICO
Middle Name:
Last Name:CHIARIELLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STATE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1453
Mailing Address - Country:US
Mailing Address - Phone:814-480-8797
Mailing Address - Fax:814-459-2303
Practice Address - Street 1:100 STATE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1453
Practice Address - Country:US
Practice Address - Phone:814-480-8797
Practice Address - Fax:814-459-2303
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008395 L103TC0700X
OH5046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008980110001Medicaid
PA1008980110001Medicaid