Provider Demographics
NPI:1417081951
Name:PSYCHOLOGICAL SERVICE ASSOCIATES,PA
Entity Type:Organization
Organization Name:PSYCHOLOGICAL SERVICE ASSOCIATES,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MUSETTO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-428-6640
Mailing Address - Street 1:49 GROVE ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1232
Mailing Address - Country:US
Mailing Address - Phone:856-428-6640
Mailing Address - Fax:856-428-9185
Practice Address - Street 1:49 GROVE ST
Practice Address - Street 2:SUITE C
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-1232
Practice Address - Country:US
Practice Address - Phone:856-428-6640
Practice Address - Fax:856-428-9185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00102900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0825470000OtherAMERIHEALTH