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General NPI Number Information
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NPI Number | 1982148474
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Entity Type | Organization
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Legal Business Name | WELLQOR PSYCHOLOGICAL SERVICES OF FLORIDA, PA
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 12/19/2016
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Provider Practice Location Address
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Address Line | 100 BRADFORD RD SUITE 200
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City | WEXFORD
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State | PA
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Zip | 15090-8486
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Country | US
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Telephone | 724-719-2833
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BRADFORD RD SUITE 200
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City | WEXFORD
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State | PA
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Zip | 15090-8486
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAUL NUSSBAUM
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Credential | PHD
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Telephone | 724-719-2833
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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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