MEDICARE: CHILD AND ADOLESCENT CLINICAL ASSOCIATES, 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	PS004396-L	PA

General Provider Information

NPI Number	:	1518070515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILD AND ADOLESCENT CLINICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	501 SMITH DR STE 6
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-4133
Country	:	US
Telephone Number	:	724-776-0350
Fax Number	:	724-776-5244

Provider Business Practice Location Address
First Line	:	501 SMITH DR STE 6
Second Line	:
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-4133
Country	:	US
Telephone Number	:	724-776-0350
Fax Number	:	724-776-5244

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT MICHAEL ANDOLINA
Credential	:	PH.D.
Telephone Number	:	724-776-0350

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	03/11/2008

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