Healthcare Provider Details

I. General information

NPI: 1588143770
Provider Name (Legal Business Name): TROY PSYCHOLOGICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 ELMIRA ST. SUITE B
TROY PA
16947-1202
US

IV. Provider business mailing address

122 ELMIRA ST. SUITE B
TROY PA
16947-1202
US

V. Phone/Fax

Practice location:
  • Phone: 570-529-6060
  • Fax: 570-529-6069
Mailing address:
  • Phone: 570-529-6060
  • Fax: 570-529-6069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9548
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number9548
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number9548
License Number StatePA

VIII. Authorized Official

Name: SARAH MAXWELL GATES
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 570-529-6060