Provider Demographics
NPI:1134178304
Name:COMMUNITY PSYCHOLOGICAL CENTER, INC.
Entity type:Organization
Organization Name:COMMUNITY PSYCHOLOGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CATINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-588-1439
Mailing Address - Street 1:715 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:PA
Mailing Address - Zip Code:18013-1740
Mailing Address - Country:US
Mailing Address - Phone:610-588-1439
Mailing Address - Fax:610-588-3236
Practice Address - Street 1:715 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:PA
Practice Address - Zip Code:18013-1740
Practice Address - Country:US
Practice Address - Phone:610-588-1439
Practice Address - Fax:610-588-3236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005112L320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness