Provider Demographics
NPI:1174319578
Name:APOTHECA PSYCHIATRY LLC
Entity type:Organization
Organization Name:APOTHECA PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCH NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:DEFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:814-233-9796
Mailing Address - Street 1:219 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-5300
Mailing Address - Country:US
Mailing Address - Phone:814-233-9796
Mailing Address - Fax:
Practice Address - Street 1:507 BROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-1405
Practice Address - Country:US
Practice Address - Phone:814-233-9796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty