Provider Demographics
NPI:1134562325
Name:SANTILLI PSYCHOLOGICAL AND WELLNESS SERVICES, LLC
Entity type:Organization
Organization Name:SANTILLI PSYCHOLOGICAL AND WELLNESS SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTILLI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:412-378-1058
Mailing Address - Street 1:328 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-9225
Mailing Address - Country:US
Mailing Address - Phone:412-378-1058
Mailing Address - Fax:412-246-9383
Practice Address - Street 1:3535 ROUTE 130
Practice Address - Street 2:SUITE 2, LOWER LEVEL
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-2143
Practice Address - Country:US
Practice Address - Phone:412-378-1058
Practice Address - Fax:412-246-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X
PAPS015111103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASA056569Medicaid
PAP55588Medicare UPIN