Provider Demographics
NPI:1861235103
Name:ERICA BONCELLA LPC
Entity type:Organization
Organization Name:ERICA BONCELLA LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BONCELLA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-400-4021
Mailing Address - Street 1:3800 W 12TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3380
Mailing Address - Country:US
Mailing Address - Phone:814-400-4021
Mailing Address - Fax:
Practice Address - Street 1:3800 W 12TH ST STE 5
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3380
Practice Address - Country:US
Practice Address - Phone:814-400-4021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)