Healthcare Provider Details

I. General information

NPI: 1245564285
Provider Name (Legal Business Name): PHOENIX THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2009
Last Update Date: 11/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 BRACKEN PL
PITTSBURGH PA
15239-2548
US

IV. Provider business mailing address

51 BRACKEN PL
PITTSBURGH PA
15239-2548
US

V. Phone/Fax

Practice location:
  • Phone: 724-387-2455
  • Fax: 724-387-2456
Mailing address:
  • Phone: 724-387-2455
  • Fax: 724-387-2456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELISSA R ROMANELLI
Title or Position: PRESIDENT
Credential:
Phone: 724-387-2455