Provider Demographics
NPI:1790712156
Name:PERSOMA P.C.
Entity Type:Organization
Organization Name:PERSOMA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-823-5155
Mailing Address - Street 1:300 OXFORD DR STE 110
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-2361
Mailing Address - Country:US
Mailing Address - Phone:412-823-5155
Mailing Address - Fax:412-823-8262
Practice Address - Street 1:300 OXFORD DR STE 110
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-2361
Practice Address - Country:US
Practice Address - Phone:412-823-5155
Practice Address - Fax:412-823-8262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1583512OtherBC/BS
000630868OtherBC/BS
PA1583518OtherBC/BS