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General NPI Number Information
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NPI Number | 1083071666
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Entity Type | Organization
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Legal Business Name | EDGEWOOD PSYCHOLOGICAL PRACTICE, LLC
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Dates
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Enumeration Date | 01/27/2016
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Last Update Date | 01/27/2016
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Provider Practice Location Address
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Address Line | 121 EDGEWOOD AVE SUITE 3
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City | PITTSBURGH
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State | PA
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Zip | 15218-1593
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Country | US
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Telephone | 412-888-9021
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Fax |
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Provider Business Mailing Address
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Address Line | 121 EDGEWOOD AVE SUITE 3
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City | PITTSBURGH
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State | PA
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Zip | 15218-1593
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Country | US
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Telephone | 412-888-9021
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. REBECCA PARKER
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Credential | PSYD
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Telephone | 412-888-9021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017664
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License Number State | PA
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