Provider Demographics
NPI:1649235110
Name:RIVERSIDE ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:RIVERSIDE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:G
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:717-238-6880
Mailing Address - Street 1:2818 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-1228
Mailing Address - Country:US
Mailing Address - Phone:717-238-6880
Mailing Address - Fax:717-238-6885
Practice Address - Street 1:2818 GREEN ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-1228
Practice Address - Country:US
Practice Address - Phone:717-238-6880
Practice Address - Fax:717-238-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02433600OtherCAPITAL BLUE CROSS
PA1000022870005Medicaid
PA641061OtherHIGHMARK BLUE SHIELD
PA641061OtherHIGHMARK BLUE SHIELD