Provider Demographics
NPI:1598048308
Name:STAUFFER PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:STAUFFER PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAUFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:717-579-6715
Mailing Address - Street 1:168 KINSINGER RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032-9449
Mailing Address - Country:US
Mailing Address - Phone:717-692-5200
Mailing Address - Fax:717-692-5201
Practice Address - Street 1:560 RISING SUN LN
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1243
Practice Address - Country:US
Practice Address - Phone:717-692-5200
Practice Address - Fax:717-692-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAP5006799L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016838420002Medicaid