Provider Demographics
NPI:1164669966
Name:COMMONWEALTH PSYCHOLOGICAL SERVICES, PLC
Entity Type:Organization
Organization Name:COMMONWEALTH PSYCHOLOGICAL SERVICES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:GALLARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-437-4820
Mailing Address - Street 1:2322 BLUE STONE HILL DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-5403
Mailing Address - Country:US
Mailing Address - Phone:540-437-4820
Mailing Address - Fax:540-437-4823
Practice Address - Street 1:2322 BLUE STONE HILL DR
Practice Address - Street 2:SUITE 280
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5403
Practice Address - Country:US
Practice Address - Phone:540-437-4820
Practice Address - Fax:540-437-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003002103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001472OtherMEDICARE PTAN