Provider Demographics
NPI:1174679203
Name:WESLEY SPECTRUM SERVICES
Entity Type:Organization
Organization Name:WESLEY SPECTRUM SERVICES
Other - Org Name:THE WESLEY INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EVP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SZPARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-831-9390
Mailing Address - Street 1:243 JOHNSTON RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SAINT CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2534
Mailing Address - Country:US
Mailing Address - Phone:412-831-9390
Mailing Address - Fax:412-831-8868
Practice Address - Street 1:5499 WILLIAM FLYNN HWY
Practice Address - Street 2:
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-9675
Practice Address - Country:US
Practice Address - Phone:412-831-9390
Practice Address - Fax:412-831-8868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA422720101YM0800X, 103TB0200X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA329484760504OtherVBH OF PA
PA1001340160012Medicaid