=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396908380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT F COUFAL PHD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2008
-----------------------------------------------------
Last Update Date | 07/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5701 CENTRE AVE STE L11
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-3787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-362-1470
-----------------------------------------------------
Fax | 412-362-1472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5701 CENTRE AVE STE L11
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15206-3787
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-362-1470
-----------------------------------------------------
Fax | 412-362-1472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT COUFAL
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 412-362-1470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0200X
-----------------------------------------------------
Taxonomy Name | Forensic Psychologist
-----------------------------------------------------
License Number | PS005360L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------