1518070515 NPI number — CHILD AND ADOLESCENT CLINICAL ASSOCIATES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518070515 NPI number — CHILD AND ADOLESCENT CLINICAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILD AND ADOLESCENT CLINICAL ASSOCIATES, INC.
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:
CLINICAL ASSOCIATES
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:
1518070515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 SMITH DR STE 6
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRANBERRY TWP
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16066-4133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-776-0350
Provider Business Mailing Address Fax Number:
724-776-5244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 SMITH DR STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-776-0350
Provider Business Practice Location Address Fax Number:
724-776-5244
Provider Enumeration Date:
08/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDOLINA
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-776-0350

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PS004396-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)





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