Provider Demographics
NPI:1730294026
Name:COGNITIVE DYNAMIC THERAPY ASSOCIATES INC
Entity Type:Organization
Organization Name:COGNITIVE DYNAMIC THERAPY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OFFICER OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:M
Authorized Official - Last Name:GLANZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:4126-687-8700
Mailing Address - Street 1:155 N CRAIG STREET
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-687-8700
Mailing Address - Fax:412-687-6808
Practice Address - Street 1:155 N CRAIG STREET
Practice Address - Street 2:SUITE 170
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-687-8700
Practice Address - Fax:412-687-6808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003484L103T00000X
PAPS003286L103T00000X
PAPS008790L103T00000X
PAPS015188L103T00000X
PAPS015150L103T00000X
PAPS008424L103T00000X
PAPS009267L103T00000X
PAPS015021L103T00000X
PAPC003890L103T00000X
PACW001050L104100000X
PACW012126L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA630549OtherHIGHMARK BLUE CROSS
PA5099423OtherAETNA
PA002122Medicare ID - Type Unspecified