Healthcare Provider Details

I. General information

NPI: 1861916470
Provider Name (Legal Business Name): SONG AND REITZ PSYCHOLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CEDAR BLVD STE 305
PITTSBURGH PA
15228-1330
US

IV. Provider business mailing address

20 CEDAR BLVD STE 305
PITTSBURGH PA
15228-1330
US

V. Phone/Fax

Practice location:
  • Phone: 412-660-3598
  • Fax: 412-668-0903
Mailing address:
  • Phone: 412-660-3598
  • Fax: 412-668-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS017481
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW015469
License Number StatePA

VIII. Authorized Official

Name: TIFFANY TIPTON SONG
Title or Position: CO OWNER
Credential: LCSW
Phone: 412-660-3598