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General NPI Number Information
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NPI Number | 1417428814
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Entity Type | Individual
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Provider Name | CARA MICHELLE CRISSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 12/10/2018
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 4 ALLEGHENY CTR FL 8
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City | PITTSBURGH
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State | PA
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Zip | 15212-5255
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Country | US
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Telephone | 412-789-6377
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Fax |
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Provider Business Mailing Address
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Address Line | 117 VIP DR STE 310
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City | WEXFORD
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State | PA
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Zip | 15090-6936
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Country | US
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Telephone | 412-789-6377
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | PS017946
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License Number State | PA
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