MEDICARE: PARKSIDE PSYCHOLOGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	103TC1900X	Counseling Psychologist
3	1041C0700X	Clinical Social Worker
4	106H00000X	Marriage & Family Therapist
5	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	518561	OTHER	PA	VALUE OPTION
2	1316981590	OTHER		NPI
3	1205081221	OTHER		GROUP NPI
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	1306866959	OTHER		NPI
7	462825	OTHER	PA	VALUE OPTIONS

General Provider Information

NPI Number	:	1205081221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKSIDE PSYCHOLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	435 CHESTNUT ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-4404
Country	:	US
Telephone Number	:	814-807-0861
Fax Number	:	814-807-0863

Provider Business Practice Location Address
First Line	:	435 CHESTNUT ST
Second Line	:
City	:	MEADVILLE
State	:	PA
Zip	:	16335-4404
Country	:	US
Telephone Number	:	814-807-0861
Fax Number	:	814-807-0863

Authorized Official
Title or Position	:	BUSINESS OWNER
Name	:	MS. AUDREY S SMITH
Credential	:	M.A.
Telephone Number	:	814-807-0861

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	11/30/2020

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Directions to “PARKSIDE PSYCHOLOGICAL ASSOCIATES ” Practice Location

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