1336447309 NPI number — COMPREHENSIVE PSYCHOLOGICAL SERVICES

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 1336447309 NPI number — COMPREHENSIVE PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE 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:
1336447309
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
274 ROUTE 940
Provider Second Line Business Mailing Address:
PO BOX 604
Provider Business Mailing Address City Name:
BLAKESLEE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18610-0604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-643-0222
Provider Business Mailing Address Fax Number:
570-643-0224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
274 ROUTE 970
Provider Second Line Business Practice Location Address:
BLAKESLEE SQUARE
Provider Business Practice Location Address City Name:
BLAKESLEE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18610-0604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-643-0222
Provider Business Practice Location Address Fax Number:
570-643-0224
Provider Enumeration Date:
03/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CORNELL
Authorized Official First Name:
SARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
570-643-0222

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS016217 , 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: 101894788 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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