Provider Demographics
NPI:1407491848
Name:CORNESTONE PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:CORNESTONE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SUNGHYE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-808-5764
Mailing Address - Street 1:201 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3522
Mailing Address - Country:US
Mailing Address - Phone:267-808-5764
Mailing Address - Fax:
Practice Address - Street 1:201 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3522
Practice Address - Country:US
Practice Address - Phone:267-808-5764
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty