Healthcare Provider Details

I. General information

NPI: 1023182847
Provider Name (Legal Business Name): RUSS DUNSTAN LICENSE PSYCHOLOGIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RALPH F DUNSTAN LICENSE PSYCHOLOGIST

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 PELLIS RD SUITE 101 TIM BRIDGES PHD & ASSOCIATES INC
GREENSBURG PA
15601
US

IV. Provider business mailing address

406 WOOD DUCK DR
GREENSBURG PA
15601-3125
US

V. Phone/Fax

Practice location:
  • Phone: 724-850-7448
  • Fax: 724-850-8143
Mailing address:
  • Phone: 724-552-2471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006500L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: