Provider Demographics
NPI:1023182847
Name:DUNSTAN, RUSS (LICENSE PSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:RUSS
Middle Name:
Last Name:DUNSTAN
Suffix:
Gender:M
Credentials:LICENSE PSYCHOLOGIST
Other - Prefix:MR
Other - First Name:RALPH
Other - Middle Name:F
Other - Last Name:DUNSTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSE PSYCHOLOGIST
Mailing Address - Street 1:406 WOOD DUCK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3125
Mailing Address - Country:US
Mailing Address - Phone:724-552-2471
Mailing Address - Fax:
Practice Address - Street 1:438 PELLIS RD SUITE 101
Practice Address - Street 2:TIM BRIDGES PHD & ASSOCIATES INC
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-850-7448
Practice Address - Fax:724-850-8143
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006500L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1816763OtherHIGHMARK BC BS
PA1816569OtherPREMIER HIGHMARK BC BS