Centerville Clinics Inc

Primary specialty

School Social WorkerTaxonomy code 1041S0200X

Legal business name

CENTERVILLE CLINICS INC

Practice address

Bower Hill Elementary School
424 Bower Hill Road
Venetia, PA 15367

Phone

(724) 941-0913

Fax

(724) 941-0918

NPI assigned

Apr 10, 2019

Last updated

Apr 10, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Barry R Niccolai

Title

Executive Director

Phone

(724) 632-6801

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554854400000",
    "number": "1306309927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CENTERVILLE CLINICS INC",
            "address_2": "1070 OLD NATIONAL PIKE ROAD",
            "city": "FREDERICKTOWN",
            "state": "PA",
            "postal_code": "153332114",
            "telephone_number": "724-632-6801",
            "fax_number": "724-632-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BOWER HILL ELEMENTARY SCHOOL",
            "address_2": "424 BOWER HILL ROAD",
            "city": "VENETIA",
            "state": "PA",
            "postal_code": "15367",
            "telephone_number": "724-941-0913",
            "fax_number": "724-941-0918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTERVILLE CLINICS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-10",
        "last_updated": "2019-04-10",
        "status": "A",
        "authorized_official_last_name": "NICCOLAI",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "724-632-6801",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1041S0200X",
            "taxonomy_group": "",
            "desc": "Social Worker, School",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007288440027",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittney Barr, CCC-SLP
• Jennifer Lee Bateson
• Rachel Dekman, OTD, OTR/L
• Sarah Delongpre
• Autumn Dzadovsky, CCC-SLP
• Kenneth Edgar, MD
• Kyra Jewel Franklin, PA-C

• School Social Worker in Venetia, PA
• Providers in Venetia, PA by specialty
• School Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.