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General NPI Number Information
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NPI Number | 1952530891
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Entity Type | Organization
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Legal Business Name | SEED IN THE SOOT LLC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 05/01/2016
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Provider Practice Location Address
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Address Line | 2720 SHADY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15217-2462
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Country | US
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Telephone | 412-297-1514
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Fax | 412-945-5810
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Provider Business Mailing Address
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Address Line | 2720 SHADY AVE
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City | PITTSBURGH
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State | PA
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Zip | 15217-2462
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Country | US
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Telephone | 412-297-1514
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Fax | 412-945-5810
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Authorized Official
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Title or Position | OWNER
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Name | DR. SANDRA H BANKS
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Credential | PH.D.
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Telephone | 412-297-1514
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PS016487
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS016487
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License Number State | PA
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