Provider Demographics
NPI:1578534442
Name:PSYCHOLOGICAL ASSOCIATES OF SCHUYLKILL COUNTY, LLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES OF SCHUYLKILL COUNTY, LLC
Other - Org Name:PSYCHOLOGICAL ASSOCIATES OF SCHUYLKILL COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:RENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-622-1025
Mailing Address - Street 1:115 SOUTH CENTRE STREET LOWER LEVEL
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2706
Mailing Address - Country:US
Mailing Address - Phone:570-622-1025
Mailing Address - Fax:570-628-4344
Practice Address - Street 1:115 SOUTH CENTRE STREET LOWER LEVEL
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2706
Practice Address - Country:US
Practice Address - Phone:570-622-1025
Practice Address - Fax:570-628-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA920277OtherPABLUE SHIELD
PA115066Medicare PIN