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General NPI Number Information
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NPI Number | 1043457013
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Entity Type | Organization
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Legal Business Name | SHADYSIDE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/13/2009
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Last Update Date | 01/13/2009
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Provider Practice Location Address
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Address Line | 5200 CENTRE AVE SUITE 514
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City | PITTSBURGH
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State | PA
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Zip | 15232-1300
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Country | US
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Telephone | 412-683-7396
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Fax | 412-682-0502
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Provider Business Mailing Address
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Address Line | 5200 CENTRE AVE SUITE 514
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City | PITTSBURGH
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State | PA
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Zip | 15232-1300
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Country | US
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Telephone | 412-683-7396
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Fax | 412-682-0502
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Authorized Official
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Title or Position | OWNER
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Name | PAUL J FRIDAY
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Credential | PHD
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Telephone | 412-683-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS002382L
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License Number State | PA
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