Basic Information
| Provider Information | |||||||||
| NPI: | 1093948820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WASHINGTON PHYSICIAN SERVICES ORGANIZATION | ||||||||
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| OtherOrganizationName: | WASHINGTON HEALTH SYSTEM BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 LEONARD AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245791075 | ||||||||
| FaxNumber: | 7242492833 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 LEONARD AVE | ||||||||
| Address2: | STE 300 | ||||||||
| City: | WASHINGTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153013368 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7245791075 | ||||||||
| FaxNumber: | 7242492833 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2009 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | SCANLON | ||||||||
| AuthorizedOfficialFirstName: | MAUREEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7242291756 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WASHINGTON HEALTH CARE SERVICES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD047902L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.