Provider Demographics
NPI:1942370374
Name:MORELLO, VINCENT JAMES (PHD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JAMES
Last Name:MORELLO
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 1:987 OLD EAGLE SCHOOL RD
Mailing Address - Street 2:WAYNE COUNSELING CENTER
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-1708
Mailing Address - Country:US
Mailing Address - Phone:717-203-6628
Mailing Address - Fax:
Practice Address - Street 1:987 OLD EAGLE SCHOOL RD
Practice Address - Street 2:WAYNE COUNSELING CENTER
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1708
Practice Address - Country:US
Practice Address - Phone:717-203-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004461-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMO462164Medicare ID - Type Unspecified
PA462164RQLMedicare ID - Type Unspecified