Provider Demographics
NPI:1326368374
Name:RALPH E. LANDEFELD PH.D. P.C.
Entity Type:Organization
Organization Name:RALPH E. LANDEFELD PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:LANDEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:724-601-4901
Mailing Address - Street 1:10159 NANCY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335
Mailing Address - Country:US
Mailing Address - Phone:814-336-5387
Mailing Address - Fax:814-817-1416
Practice Address - Street 1:15957 CONNEAUT LAKE RD.
Practice Address - Street 2:SUITE 7
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-336-5387
Practice Address - Fax:814-807-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002990L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0146700Medicaid
R06763Medicare UPIN