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General NPI Number Information
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NPI Number | 1205113404
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Entity Type | Organization
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Legal Business Name | DORMONT PSYCHOLOGICAL SERVICES LLC
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 3043 W LIBERTY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-2460
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Country | US
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Telephone | 412-719-0957
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Fax | 877-742-6060
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Provider Business Mailing Address
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Address Line | 3043 W LIBERTY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15216-2460
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Country | US
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Telephone | 412-719-0957
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Fax | 877-742-6060
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. KIM T HOFFMAN
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Credential | PH.D.
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Telephone | 412-719-0957
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | PS 016547
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License Number State | PA
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