Provider Demographics
NPI:1801988506
Name:CHISWICK, NANCY R (PHD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:R
Last Name:CHISWICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S ALLEN ST
Mailing Address - Street 2:SUITE 218
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-4849
Mailing Address - Country:US
Mailing Address - Phone:814-234-3010
Mailing Address - Fax:814-234-2170
Practice Address - Street 1:315 S ALLEN ST
Practice Address - Street 2:SUITE 218
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-4849
Practice Address - Country:US
Practice Address - Phone:814-234-3010
Practice Address - Fax:814-234-2170
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-002082-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30190Medicare ID - Type Unspecified