MEDICARE: CRANBERRY PSYCHOLOGICAL SERVICES, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS015442	PA

General Provider Information

NPI Number	:	1508891433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CRANBERRY PSYCHOLOGICAL SERVICES, INC.

Provider Business Mailing Address
First Line	:	1000 STONEWOOD DR
Second Line	:	SUITE 302
City	:	WEXFORD
State	:	PA
Zip	:	15090-8386
Country	:	US
Telephone Number	:	724-935-1599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 STONEWOOD DR
Second Line	:	SUITE 302
City	:	WEXFORD
State	:	PA
Zip	:	15090-8386
Country	:	US
Telephone Number	:	724-935-1599
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAURIE MARIE DONALDSON
Credential	:	PH.D.
Telephone Number	:	724-935-1599

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	10/30/2007

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