=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710353016
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PITTSBURGH PSYCHIATRIC AND PSYCHOLOGICAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2015
-----------------------------------------------------
Last Update Date | 08/20/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2008 MURRAY AVE SUITE A2
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15217-2169
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-278-5000
-----------------------------------------------------
Fax | 412-455-6723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 VALLEY DR
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15215-1707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-303-3045
-----------------------------------------------------
Fax | 412-455-6723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | KEVIN CARL
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 517-303-3045
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | MD443748
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------