Provider Demographics
NPI:1225125479
Name:COMMONWEALTH AFFILIATED SERVICES, INC
Entity Type:Organization
Organization Name:COMMONWEALTH AFFILIATED SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:J
Authorized Official - Last Name:CADIEUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-540-5353
Mailing Address - Street 1:2215 FOREST HILLS DR
Mailing Address - Street 2:SUITE 38
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1099
Mailing Address - Country:US
Mailing Address - Phone:717-540-5353
Mailing Address - Fax:717-540-5151
Practice Address - Street 1:2215 FOREST HILLS DR
Practice Address - Street 2:SUITE 38
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1099
Practice Address - Country:US
Practice Address - Phone:717-540-5353
Practice Address - Fax:717-540-5151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000112101YM0800X
PAPS007421L103T00000X
PAPS005345L103T00000X
PAPS003544L103TC0700X
PACW001341L1041C0700X
PACW003986L1041C0700X
PAMD020877E2084N0400X
PAMD039464E2084P0804X
PAMD039381E2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Not Answered2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1823824OtherHIGHMARK BLUE SHIELD
PA1823814OtherHIGHMARK BLUE SHIELD
PA50046968OtherCAPITAL BLUE CROSS