Provider Demographics
NPI:1891786331
Name:NORTHSHORE PSYCHOLOGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHSHORE PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWABENBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-877-8013
Mailing Address - Street 1:120 E 2ND ST
Mailing Address - Street 2:THIRD FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-877-8013
Mailing Address - Fax:814-877-8007
Practice Address - Street 1:120 E 2ND ST
Practice Address - Street 2:THIRD FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-877-8013
Practice Address - Fax:814-877-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019240150003Medicaid