Provider Demographics
NPI:1548233109
Name:REDINBAUGH, ELLEN M (PHD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:REDINBAUGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 SHADY AVE
Mailing Address - Street 2:SUITE 201C
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-4409
Mailing Address - Country:US
Mailing Address - Phone:412-425-5918
Mailing Address - Fax:412-422-9649
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:SUITE 201C
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-425-5918
Practice Address - Fax:412-422-9649
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008860L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168753OtherMEDICARE PTAN
PA036677Medicare ID - Type Unspecified
PAP03524Medicare UPIN