Provider Demographics
NPI:1922347590
Name:COLE, DEBRA HRICIK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:HRICIK
Last Name:COLE
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 1:1116 MILL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17821-1078
Mailing Address - Country:US
Mailing Address - Phone:570-490-0075
Mailing Address - Fax:570-271-1995
Practice Address - Street 1:1116 MILL ST STE 102
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17821-1078
Practice Address - Country:US
Practice Address - Phone:570-490-0075
Practice Address - Fax:570-271-1995
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-02
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005986L103TC0700X, 103TC2200X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027911860001Medicaid