Provider Demographics
NPI:1447235379
Name:COMMUNITY PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:COMMUNITY PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:VELLELA
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:610-434-2431
Mailing Address - Street 1:2341 WALBERT AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1351
Mailing Address - Country:US
Mailing Address - Phone:610-434-2431
Mailing Address - Fax:610-434-8384
Practice Address - Street 1:2341 WALBERT AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-1351
Practice Address - Country:US
Practice Address - Phone:610-434-2431
Practice Address - Fax:610-434-8384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004488L103T00000X, 103TA0400X, 103TC0700X, 103TC1900X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02988501OtherCAPITAL BLUE CROSS
PAVE454291OtherHIGHMARK BLUE SHIELD