Provider Demographics
NPI:1417904137
Name:PSYCHOLOGICAL HEALTH ASSOCIATES, PA
Entity Type:Organization
Organization Name:PSYCHOLOGICAL HEALTH ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRASNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:919-467-2876
Mailing Address - Street 1:102 COMMONWEALTH CT
Mailing Address - Street 2:STE H
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4437
Mailing Address - Country:US
Mailing Address - Phone:919-467-2876
Mailing Address - Fax:919-467-6871
Practice Address - Street 1:102 COMMONWEALTH CT
Practice Address - Street 2:STE H
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4437
Practice Address - Country:US
Practice Address - Phone:919-467-2876
Practice Address - Fax:919-467-6871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC751103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0267GOtherBLUE CROSS/ BLUE SHIELD