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General NPI Number Information
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NPI Number | 1427264407
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Entity Type | Organization
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Legal Business Name | PSYCHOTHERAPY SERVICES OF CRANBERRY, P.C.
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 215 EXECUTIVE DR SUITE 102
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6406
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Country | US
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Telephone | 724-776-5690
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Fax | 724-776-5611
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Provider Business Mailing Address
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Address Line | 215 EXECUTIVE DR SUITE 102
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-6406
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Country | US
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Telephone | 724-776-5690
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Fax | 724-776-5611
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT S. BODNAR
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Credential | PH.D.
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Telephone | 724-776-5690
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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-003621-L
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License Number State | PA
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