Provider Demographics
NPI:1497227086
Name:AVELLAR, TODD RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:RAYMOND
Last Name:AVELLAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MURRAY AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2352
Mailing Address - Country:US
Mailing Address - Phone:559-316-9358
Mailing Address - Fax:
Practice Address - Street 1:2345 MURRAY AVE STE 305
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2352
Practice Address - Country:US
Practice Address - Phone:559-316-9358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018510103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist