Healthcare Provider Details

I. General information

NPI: 1427342427
Provider Name (Legal Business Name): CASSANDRA BRENNER WONG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 BINGHAM ST
PITTSBURGH PA
15203-1101
US

IV. Provider business mailing address

1011 BINGHAM ST
PITTSBURGH PA
15203-1101
US

V. Phone/Fax

Practice location:
  • Phone: 412-235-5445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberTPS030091
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberTPS030091
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberTPS030091
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: