=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720723182
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVELLAR WARDEN PSYCHOLOGICAL ASSOCIATES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2022
-----------------------------------------------------
Last Update Date | 04/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2345 MURRAY AVE STE 305
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15217-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-316-9358
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2345 MURRAY AVE STE 305
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15217-2352
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST; CO-OWNER
-----------------------------------------------------
Name | DR. TODD R. AVELLAR
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 559-316-9358
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------