1598048308 NPI number — STAUFFER PSYCHOLOGICAL SERVICES

Table of content: (NPI 1598048308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598048308 NPI number — STAUFFER PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STAUFFER PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598048308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
168 KINSINGER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALIFAX
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17032-9449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-692-5200
Provider Business Mailing Address Fax Number:
717-692-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 RISING SUN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17061-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-692-5200
Provider Business Practice Location Address Fax Number:
717-692-5201
Provider Enumeration Date:
09/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STAUFFER
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
717-579-6715

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  P5006799L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0016838420002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".