Healthcare Provider Details

I. General information

NPI: 1710353016
Provider Name (Legal Business Name): PITTSBURGH PSYCHIATRIC AND PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 MURRAY AVE SUITE A2
PITTSBURGH PA
15217-2169
US

IV. Provider business mailing address

215 VALLEY DR
PITTSBURGH PA
15215-1707
US

V. Phone/Fax

Practice location:
  • Phone: 412-278-5000
  • Fax: 412-455-6723
Mailing address:
  • Phone: 517-303-3045
  • Fax: 412-455-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberMD443748
License Number StatePA

VIII. Authorized Official

Name: KEVIN CARL
Title or Position: MD
Credential: MD
Phone: 517-303-3045