Provider Demographics
NPI:1700046174
Name:CROYLE-SERBIN THERAPEUTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:CROYLE-SERBIN THERAPEUTIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERBIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-341-4389
Mailing Address - Street 1:290 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3764
Mailing Address - Country:US
Mailing Address - Phone:814-341-4389
Mailing Address - Fax:724-801-8153
Practice Address - Street 1:290 GRANT ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3764
Practice Address - Country:US
Practice Address - Phone:814-341-4389
Practice Address - Fax:724-801-8153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001067-E1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA638934Medicare PIN