Provider Demographics
NPI:1235185257
Name:FALLICA, ANTHONY J JR (PHD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:FALLICA
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 4TH AVE
Mailing Address - Street 2:SUITE 1709
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1706
Mailing Address - Country:US
Mailing Address - Phone:412-281-8068
Mailing Address - Fax:
Practice Address - Street 1:239 4TH AVE
Practice Address - Street 2:SUITE 1709
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-1706
Practice Address - Country:US
Practice Address - Phone:412-281-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002698L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA024701OtherHIGHMARK BC BS
PAP00064854OtherRAILROAD MEDICARE
PA01933730Medicaid
PA024701Medicare ID - Type Unspecified
PA01933730Medicaid