Provider Demographics
NPI:1609803469
Name:CRITELLI, PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CRITELLI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 IROQUOIS DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3373
Mailing Address - Country:US
Mailing Address - Phone:616-248-4738
Mailing Address - Fax:616-248-4745
Practice Address - Street 1:858 IROQUOIS DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3373
Practice Address - Country:US
Practice Address - Phone:616-248-4738
Practice Address - Fax:616-248-4745
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4590519OtherAETNA
MI68OC445030OtherBLUE CROSS BLUE SHIELD
MI7419464OtherCIGNA BEHAVIORAL HEALTH
MI041872OtherVALUEOPTIONS