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General NPI Number Information
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NPI Number | 1972155380
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Entity Type | Organization
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Legal Business Name | COMMUNITY DIAGNOSTIC CENTER FOR CHILDREN
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Dates
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Enumeration Date | 07/15/2019
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 160 N CRAIG ST STE 118
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City | PITTSBURGH
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State | PA
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Zip | 15213-2714
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Country | US
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Telephone | 412-654-8263
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Fax |
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Provider Business Mailing Address
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Address Line | 332 W PENN PL
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City | PITTSBURGH
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State | PA
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Zip | 15224-2224
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Country | US
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Telephone | 412-654-8263
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA WALTERS
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Credential | PHD, NCSP
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Telephone | 412-654-8263
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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 |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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