Healthcare Provider Details

I. General information

NPI: 1346277944
Provider Name (Legal Business Name): WILLIAM JOSEPH HAWTHORNE III PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 PENN CENTER BLVD STE 400
PITTSBURGH PA
15235-5441
US

IV. Provider business mailing address

201 PENN CENTER BLVD STE 400
PITTSBURGH PA
15235-5441
US

V. Phone/Fax

Practice location:
  • Phone: 412-242-3050
  • Fax: 412-533-3325
Mailing address:
  • Phone: 412-825-5149
  • Fax: 412-533-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS-004929-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS-004929-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: