Provider Demographics
NPI:1417941063
Name:CENTER FOR PSYCHOLOGICAL SERVICES FOR TWIN CITIES, PA
Entity Type:Organization
Organization Name:CENTER FOR PSYCHOLOGICAL SERVICES FOR TWIN CITIES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:MADALINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:651-735-4841
Mailing Address - Street 1:245 RUTH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4323
Mailing Address - Country:US
Mailing Address - Phone:651-735-4841
Mailing Address - Fax:651-735-8359
Practice Address - Street 1:245 RUTH ST N
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4323
Practice Address - Country:US
Practice Address - Phone:651-735-4841
Practice Address - Fax:651-735-8359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC05879Medicare PIN