Provider Demographics
NPI:1083071666
Name:EDGEWOOD PSYCHOLOGICAL PRACTICE, LLC
Entity Type:Organization
Organization Name:EDGEWOOD PSYCHOLOGICAL PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:412-888-9021
Mailing Address - Street 1:121 EDGEWOOD AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1593
Mailing Address - Country:US
Mailing Address - Phone:412-888-9021
Mailing Address - Fax:
Practice Address - Street 1:121 EDGEWOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1593
Practice Address - Country:US
Practice Address - Phone:412-888-9021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017664103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty