Provider Demographics
NPI:1023022704
Name:KANE, MAXINE PALLAS (PHD)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:PALLAS
Last Name:KANE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N CRAIG ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1565
Mailing Address - Country:US
Mailing Address - Phone:412-621-3777
Mailing Address - Fax:412-622-7595
Practice Address - Street 1:230 N CRAIG ST
Practice Address - Street 2:SUITE B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1565
Practice Address - Country:US
Practice Address - Phone:412-621-3777
Practice Address - Fax:412-622-7595
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003791L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA456601OtherBC/BS
PA456601Medicare ID - Type Unspecified
PA456601OtherBC/BS