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General NPI Number Information
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NPI Number | 1801574181
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Entity Type | Organization
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Legal Business Name | ONLINE CARE GROUP PA-PC
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Dates
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Enumeration Date | 07/07/2023
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Last Update Date | 07/07/2023
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Provider Practice Location Address
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Address Line | 90 MARYLAND AVE
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City | WEST MIFFLIN
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State | PA
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Zip | 15122-4043
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Country | US
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Telephone | 540-769-7891
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1009
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City | EAST ARLINGTON
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State | MA
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Zip | 02474-0020
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Country | US
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Telephone | 540-769-7891
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Fax |
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Authorized Official
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Title or Position | SVP
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Name | BRADFORD GRAY
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Credential |
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Telephone | 617-204-3544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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