1295705317 NPI number — SPRINGFIELD PSYCHOLOGICAL PC

Table of content: (NPI 1295705317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295705317 NPI number — SPRINGFIELD PSYCHOLOGICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPRINGFIELD PSYCHOLOGICAL PC
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:
ASSOCIATES OF SPRINGFIELD PSYCHOLOGICAL
Provider Other Organization Name Type Code:
3
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:
1295705317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1489 BALTIMORE PIKE
Provider Second Line Business Mailing Address:
BLDG. 200, SUITE 250
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19064-3958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-544-2110
Provider Business Mailing Address Fax Number:
610-604-9510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1489 BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
BLDG. 200, SUITE 250
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-3958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-544-2110
Provider Business Practice Location Address Fax Number:
610-604-9510
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PESCE
Authorized Official First Name:
ELISABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
904-605-4986

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  PS003470-L , 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: 0261150000 . This is a "MAGELLAN" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".
  • Identifier: 202603000 . This is a "AETNA" identifier , issued by the state of ( PW ) . This identifiers is of the category "OTHER".




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