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General NPI Number Information
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NPI Number | 1194266254
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Entity Type | Organization
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Legal Business Name | EDINBORO COUNSELING AND PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/09/2017
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Last Update Date | 11/02/2023
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Provider Practice Location Address
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Address Line | 7052 ROUTE 6N
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City | EDINBORO
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State | PA
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Zip | 16412-9610
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Country | US
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Telephone | 814-734-3975
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Fax | 814-734-1265
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Provider Business Mailing Address
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Address Line | 7052 ROUTE 6N
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City | EDINBORO
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State | PA
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Zip | 16412-9610
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Country | US
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Telephone | 814-734-3975
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Fax | 814-734-1265
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | DR. VICTOR MASONE JR.
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Credential | PH.D.
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Telephone | 814-734-3975
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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 | PS-003450-L
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License Number State | PA
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