Provider Demographics
NPI:1295721249
Name:MARY AND ALEXANDER LAUGHLIN CHILDREN'S CENTER
Entity type:Organization
Organization Name:MARY AND ALEXANDER LAUGHLIN CHILDREN'S CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:FLOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-741-4087
Mailing Address - Street 1:424 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1523
Mailing Address - Country:US
Mailing Address - Phone:412-741-4087
Mailing Address - Fax:412-741-6808
Practice Address - Street 1:424 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1523
Practice Address - Country:US
Practice Address - Phone:412-741-4087
Practice Address - Fax:412-741-6808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY & ALEXANDER LAUGHLIN CHILDREN'S CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-26
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA429437OtherBCBS - PREMIERE NETWORK
PA0015858230002Medicaid
351738000OtherMAGELLAN BEHAVIORAL HEALT
=========OtherTRICARE