Provider Demographics
NPI:1760777999
Name:PHOENIX, XANDER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:XANDER
Middle Name:
Last Name:PHOENIX
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 COCHRANS MILLS ROAD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236
Mailing Address - Country:US
Mailing Address - Phone:412-386-5270
Mailing Address - Fax:
Practice Address - Street 1:636 COCHRANS MILLS ROAD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236
Practice Address - Country:US
Practice Address - Phone:412-386-5270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103T00000XBehavioral Health & Social Service ProvidersPsychologist