Provider Demographics
NPI:1184664344
Name:KLEISSAS, AMY DIANE
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:DIANE
Last Name:KLEISSAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSYCHOLOGICAL ASSOCIATES INC
Mailing Address - Street 2:STE 204
Mailing Address - City:ALLISON PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15101
Mailing Address - Country:US
Mailing Address - Phone:412-486-2948
Mailing Address - Fax:412-486-5676
Practice Address - Street 1:PSYCHOLOGICAL ASSOCIATES INC
Practice Address - Street 2:STE 204
Practice Address - City:ALLISON PARK
Practice Address - State:PA
Practice Address - Zip Code:15101
Practice Address - Country:US
Practice Address - Phone:412-486-2948
Practice Address - Fax:412-486-5676
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALPC001422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional