Provider Demographics
NPI:1629514385
Name:RADIANT BEING PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:RADIANT BEING PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENIESER-DEROSA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:610-310-7342
Mailing Address - Street 1:1848 CANDLEWYCK LN
Mailing Address - Street 2:
Mailing Address - City:GREEN LANE
Mailing Address - State:PA
Mailing Address - Zip Code:18054-2047
Mailing Address - Country:US
Mailing Address - Phone:610-310-7342
Mailing Address - Fax:
Practice Address - Street 1:80 GRAVEL PIKE UNIT B
Practice Address - Street 2:
Practice Address - City:RED HILL
Practice Address - State:PA
Practice Address - Zip Code:18076-1428
Practice Address - Country:US
Practice Address - Phone:484-624-2415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health