Provider Demographics
NPI:1811437601
Name:DR. JOHN CAROSSO PSYD & ASSOCIATES INC
Entity type:Organization
Organization Name:DR. JOHN CAROSSO PSYD & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:412-372-8000
Mailing Address - Street 1:339 HAYMAKER RD
Mailing Address - Street 2:SUITE 1104 PARKWAY BLDG
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-1435
Mailing Address - Country:US
Mailing Address - Phone:412-372-8000
Mailing Address - Fax:724-733-7670
Practice Address - Street 1:4615 FOREST RIDGE CT
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-2137
Practice Address - Country:US
Practice Address - Phone:412-372-8000
Practice Address - Fax:724-733-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009244L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty