Healthcare Provider Details

I. General information

NPI: 1891786331
Provider Name (Legal Business Name): NORTHSHORE PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST THIRD FLOOR
ERIE PA
16507-1537
US

IV. Provider business mailing address

120 E 2ND ST THIRD FLOOR
ERIE PA
16507-1537
US

V. Phone/Fax

Practice location:
  • Phone: 814-877-8013
  • Fax: 814-877-8007
Mailing address:
  • Phone: 814-877-8013
  • Fax: 814-877-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SCHWABENBAUER
Title or Position: PARTNER
Credential: PHD
Phone: 814-877-8013