Provider Demographics
NPI:1225077845
Name:GETTLE, JUDY A (PHD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:GETTLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2851
Mailing Address - Country:US
Mailing Address - Phone:412-242-8707
Mailing Address - Fax:412-242-4407
Practice Address - Street 1:4716 ELLSWORTH AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2851
Practice Address - Country:US
Practice Address - Phone:412-242-8707
Practice Address - Fax:412-242-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006772L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009737510001Medicaid
PAP00185527OtherRAILROAD MEDICARE
PA158420OtherHIGHMARK BC BS
PA1009737510001Medicaid
PA158420OtherHIGHMARK BC BS