1972759413 NPI number — A & A PSYCHOLOGICAL SERVICE PC

Table of content: (NPI 1972759413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972759413 NPI number — A & A PSYCHOLOGICAL SERVICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A & A PSYCHOLOGICAL SERVICE 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:
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:
1972759413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 STONE QUARRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONACA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15061-2448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-630-3978
Provider Business Mailing Address Fax Number:
724-728-3160

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 DARR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARRELL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16121-2022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-630-3978
Provider Business Practice Location Address Fax Number:
724-728-3160
Provider Enumeration Date:
08/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LIMERICK-GNAS
Authorized Official First Name:
SHANNON
Authorized Official Middle Name:
MARY
Authorized Official Title or Position:
LICENSED PSYCHOLOGIST
Authorized Official Telephone Number:
724-630-3978

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  PS006277 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TB0200X , with the licence number: PS 006277 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PS006277 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: PS006277 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC1900X , with the licence number: PS006277-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X , with the licence number: PS006277 L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TF0000X , with the licence number: PS006277-L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1019938840 0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 968069 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 500833 . This is a "HIGHMARK BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MASTER LEVEL THER . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".