Provider Demographics
NPI:1164841052
Name:STATE COLLEGE PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:STATE COLLEGE PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VINCA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:267-970-8914
Mailing Address - Street 1:1315 S ALLEN ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5923
Mailing Address - Country:US
Mailing Address - Phone:814-419-5463
Mailing Address - Fax:
Practice Address - Street 1:1315 S ALLEN ST
Practice Address - Street 2:SUITE 303
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5923
Practice Address - Country:US
Practice Address - Phone:814-419-5463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty