Provider Demographics
NPI:1780606178
Name:SCHALLER, JOSEPH G (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:SCHALLER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W LANCASTER AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3938
Mailing Address - Country:US
Mailing Address - Phone:610-995-0189
Mailing Address - Fax:610-995-0194
Practice Address - Street 1:303 W LANCASTER AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3938
Practice Address - Country:US
Practice Address - Phone:610-995-0189
Practice Address - Fax:610-995-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009283L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA336520OtherMAGELLAN
PA1400145OtherHIGHMARK BLUE SHIELD
PA1400145OtherINDEPENDENCE BLUE CROSS
PA099752Medicare ID - Type Unspecified