Provider Demographics
NPI:1013965706
Name:TRILLIZIO, MICHAEL A (MA, NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:TRILLIZIO
Suffix:
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 CENTRAL AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:OIL CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16301-2617
Mailing Address - Country:US
Mailing Address - Phone:814-678-6826
Mailing Address - Fax:
Practice Address - Street 1:240 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-1829
Practice Address - Country:US
Practice Address - Phone:814-673-9975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002689101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor