Provider Demographics
NPI:1972759413
Name:A & A PSYCHOLOGICAL SERVICE PC
Entity Type:Organization
Organization Name:A & A PSYCHOLOGICAL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:LIMERICK-GNAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:724-630-3978
Mailing Address - Street 1:190 STONE QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2448
Mailing Address - Country:US
Mailing Address - Phone:724-630-3978
Mailing Address - Fax:724-728-3160
Practice Address - Street 1:500 DARR AVE
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-2022
Practice Address - Country:US
Practice Address - Phone:724-630-3978
Practice Address - Fax:724-728-3160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006277 L103T00000X, 103TC0700X, 103TC1900X, 103TC2200X
PAPS 006277 L103TB0200X
PAPS006277-L103TC1900X, 103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019938840 0001Medicaid
PA968069OtherHIGHMARK BLUE CROSS BLUE SHIELD
PA500833OtherHIGHMARK BLUE CROSS BLUE SHIELD
PAMASTER LEVEL THEROtherUPMC