Provider Demographics
NPI:1902386261
Name:PREMIER HEALTH PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR & LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SIMONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:267-890-7233
Mailing Address - Street 1:522 GRAYSON LN
Mailing Address - Street 2:
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438
Mailing Address - Country:US
Mailing Address - Phone:267-890-7233
Mailing Address - Fax:
Practice Address - Street 1:173 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-2514
Practice Address - Country:US
Practice Address - Phone:267-890-7233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017738103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1154587715Medicaid