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General NPI Number Information
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NPI Number | 1962461236
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Entity Type | Organization
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Legal Business Name | CENTER FOR INTEGRATIVE PSYCHOTHERAPY PC
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 03/04/2011
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Provider Practice Location Address
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Address Line | 1251 S CEDAR CREST BLVD SUITE 211D
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City | ALLENTOWN
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State | PA
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Zip | 18103-6205
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Country | US
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Telephone | 610-432-5066
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Fax | 610-432-0973
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Provider Business Mailing Address
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Address Line | 1251 S CEDAR CREST BLVD SUITE 211D
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City | ALLENTOWN
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State | PA
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Zip | 18103-6205
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Country | US
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Telephone | 610-432-5066
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Fax | 610-432-0973
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Authorized Official
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Title or Position | DIRECTOR/CLINICAL PSYCHOLOGIST
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Name | MR. JESUS ALBERTO SALAS
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Credential | PSY.D.
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Telephone | 610-432-5066
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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 | PS015605
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License Number State | PA
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