Provider Demographics
NPI:1780827295
Name:DR. LARRY V. PACOE
Entity Type:Organization
Organization Name:DR. LARRY V. PACOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:V
Authorized Official - Last Name:PACOE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-683-8300
Mailing Address - Street 1:230 N CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1565
Mailing Address - Country:US
Mailing Address - Phone:412-683-8300
Mailing Address - Fax:412-687-1880
Practice Address - Street 1:230 N CRAIG ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1565
Practice Address - Country:US
Practice Address - Phone:412-683-8300
Practice Address - Fax:412-687-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001163L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPA29801Medicare PIN
PAR05563Medicare UPIN