Provider Demographics
NPI:1720466410
Name:THE OFFICES OF DAVID PRYBOCK PHD LLC
Entity Type:Organization
Organization Name:THE OFFICES OF DAVID PRYBOCK PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYBOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-952-5348
Mailing Address - Street 1:134 S HIGHLAND AVE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3968
Mailing Address - Country:US
Mailing Address - Phone:412-952-5348
Mailing Address - Fax:
Practice Address - Street 1:134 S HIGHLAND AVE
Practice Address - Street 2:SUITE 17
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3968
Practice Address - Country:US
Practice Address - Phone:412-952-5348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102993851 0001Medicaid
PA193360Medicare PIN