Individual provider Active NPI

Renata Ellen Harland, PH.D.

  • Clinical Neuropsychologist
  • Erie, PA
National Provider Identifier
1104928266
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
PS016407 Issued in PA
Practice address
1611 Peach St Ste 105
Erie, PA 16501-2120
Phone
(814) 440-7909
Fax
(814) 240-6886
NPI assigned
Sep 1, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X PS016407 PA Primary

Addresses

Primary practice location

1611 Peach St Ste 105
Erie, PA 16501-2120

Mailing address

1611 Peach St Ste 105
Erie, PA 16501-2120
Phone (814) 440-7909

Other identifiers 1

IdentifierTypeStateIssuer
6000663MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080422000599 PA Practitioner - Clinical Psychologist 4587634696 Practice locations: Erie, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1611 Peach St
Suite 105
Erie, PA 16501-2120
Phone (814) 440-7909

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS016407PAMDClinical Neuropsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Baron T. Denniston M.D. Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615248000000",
    "number": "1104928266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 PEACH ST STE 105",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165012120",
            "telephone_number": "814-440-7909",
            "fax_number": "814-240-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 PEACH ST STE 105",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165012120",
            "telephone_number": "814-440-7909",
            "fax_number": "814-240-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARLAND",
        "first_name": "RENATA",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "PA",
            "license": "PS016407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000663",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

Verify at the official NPI Registry.