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General NPI Number Information
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NPI Number | 1518070515
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Entity Type | Organization
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Legal Business Name | CHILD AND ADOLESCENT CLINICAL ASSOCIATES, INC.
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 03/11/2008
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Provider Practice Location Address
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Address Line | 501 SMITH DR STE 6
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-4133
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Country | US
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Telephone | 724-776-0350
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Fax | 724-776-5244
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Provider Business Mailing Address
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Address Line | 501 SMITH DR STE 6
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City | CRANBERRY TWP
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State | PA
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Zip | 16066-4133
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Country | US
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Telephone | 724-776-0350
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Fax | 724-776-5244
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT MICHAEL ANDOLINA
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Credential | PH.D.
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Telephone | 724-776-0350
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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 | PS004396-L
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License Number State | PA
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