Provider Demographics
NPI:1124182134
Name:CLOVER PSYCHOLOGICAL ASSOCIATION
Entity Type:Organization
Organization Name:CLOVER PSYCHOLOGICAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:724-658-9398
Mailing Address - Street 1:2722 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1241
Mailing Address - Country:US
Mailing Address - Phone:724-658-9398
Mailing Address - Fax:724-656-1429
Practice Address - Street 1:2722 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1241
Practice Address - Country:US
Practice Address - Phone:724-658-9398
Practice Address - Fax:724-656-1429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005964-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1308035OtherHIGHMARK
PAIG-027786OtherMAGELLAN
PA1727016Medicaid