Provider Demographics
NPI:1053758896
Name:CONICELLA, ANTHONY CARMINE
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CARMINE
Last Name:CONICELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 CEDAR RIDGE DR APT 11
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3108
Mailing Address - Country:US
Mailing Address - Phone:412-589-7129
Mailing Address - Fax:
Practice Address - Street 1:140 CEDAR RIDGE DR APT 11
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3108
Practice Address - Country:US
Practice Address - Phone:412-589-7129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health