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General NPI Number Information
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NPI Number | 1508891433
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Entity Type | Organization
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Legal Business Name | CRANBERRY PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 10/30/2007
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Provider Practice Location Address
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Address Line | 1000 STONEWOOD DR SUITE 302
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City | WEXFORD
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State | PA
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Zip | 15090-8386
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Country | US
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Telephone | 724-935-1599
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 STONEWOOD DR SUITE 302
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City | WEXFORD
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State | PA
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Zip | 15090-8386
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Country | US
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Telephone | 724-935-1599
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAURIE MARIE DONALDSON
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Credential | PH.D.
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Telephone | 724-935-1599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS015442
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License Number State | PA
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