Gina Marie Dattilo, PSYD
Individual provider Active NPI Psychologist · Elverson, PA
NPI 1497902829 · NPPES record last updated Aug 28, 2018
Key facts
- NPI
- 1497902829
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PS017764 (PA)
- Practice address
- 293 Hopewell Rd
Elverson, PA 19520 - Phone
- (540) 209-4717
- NPI assigned
- Aug 27, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Optum Behavioral Care of Connecticut PC
Practice addresses (Care Compare)
102 Pickering Way
Suite 506
Exton, PA 19341-1330
Phone (610) 544-2110
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220301001099 | PA | Practitioner - Clinical Psychologist | 1355401530 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS017764 | PA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Springfield Psychological PC | Current |
Accepting new patients | |
| Optum Behavioral Care of Connecticut, P.C. | Current |
Accepting new patients | |
| Optum Behavioral Care of Connecticut, P.C. | Current |
Accepting new patients |
Locations
102 Pickering Way
Ste 506
Exton, PA 19341
Phone (856) 472-5092
1489 Baltimore Pike
Ste 250
Springfield, PA 19064
Phone 6105442110144
7 Neshaminy Interplex Dr
Trevose, PA 19053
7 Neshaminy Interplex Dr
Ste 411
Trevose, PA 19053
560 Van Reed Rd
Ste 301
Wyomissing, PA 19610
Phone (610) 378-9601
Interoperability endpoints
- gina.marie.dattilo.1@28623.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS017764 | PA | Yes |
Addresses
Primary practice location
293 Hopewell Rd
Elverson, PA 19520
Mailing address
293 Hopewell Rd
Elverson, PA 19520-8804
Phone (540) 209-4717
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PS017764 | Other | PA | COMMONWELATH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCU |
Other providers in Elverson, PA
- Char-Lee H Cassel
- Noelle Christine Casses-Williams
- Janet Elizabeth Cipoletta
- Clover Chiropractic SCM PC
- Shelby Coy
- Lauren Dicerchio
- Gordon R Donaldson
- Doug'S Family Pharmacy
- Dougs Family Pharmacy
- Gordon Richard Eck
All providers in Elverson, PA · Psychologist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.