Provider Demographics
NPI:1639232192
Name:PSYCHOLOGICAL CONSULTANTS AND AFFILIATES, INC.
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CONSULTANTS AND AFFILIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:740-522-2230
Mailing Address - Street 1:60 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3692
Mailing Address - Country:US
Mailing Address - Phone:740-522-2230
Mailing Address - Fax:740-522-6230
Practice Address - Street 1:60 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3692
Practice Address - Country:US
Practice Address - Phone:740-522-2230
Practice Address - Fax:740-522-6230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPS9256801Medicare ID - Type Unspecified