MEDICARE: COMMONWEALTH AFFILIATED SERVICES, INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	PC000112	PA
2	103TC0700X	Clinical Psychologist	PS003544L	PA
3	103T00000X	Psychologist	PS007421L	PA
4	103T00000X	Psychologist	PS005345L	PA
5	1041C0700X	Clinical Social Worker	CW001341L	PA
6	1041C0700X	Clinical Social Worker	CW003986L	PA
7	2084P0804X	Child & Adolescent Psychiatry Physician	MD039464E	PA
8	2084P0805X	Geriatric Psychiatry Physician	MD039381E	PA
9	2084N0400X	Neurology Physician	MD020877E	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1823824	OTHER	PA	HIGHMARK BLUE SHIELD
2	1823814	OTHER	PA	HIGHMARK BLUE SHIELD
3	50046968	OTHER	PA	CAPITAL BLUE CROSS

NPI Number	:	1225125479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH AFFILIATED SERVICES, INC

Provider Business Mailing Address
First Line	:	2215 FOREST HILLS DR
Second Line	:	SUITE 38
City	:	HARRISBURG
State	:	PA
Zip	:	17112-1099
Country	:	US
Telephone Number	:	717-540-5353
Fax Number	:	717-540-5151

Provider Business Practice Location Address
First Line	:	2215 FOREST HILLS DR
Second Line	:	SUITE 38
City	:	HARRISBURG
State	:	PA
Zip	:	17112-1099
Country	:	US
Telephone Number	:	717-540-5353
Fax Number	:	717-540-5151

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROGER J CADIEUX
Credential	:	M.D.
Telephone Number	:	717-540-5353

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	09/11/2025