Provider Demographics
NPI:1154604007
Name:KEYSTONE PSYCHOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:KEYSTONE PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:267-847-9560
Mailing Address - Street 1:3502 SCOTTS LANE
Mailing Address - Street 2:BUILDING 1 SUITE 114
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129
Mailing Address - Country:US
Mailing Address - Phone:267-847-9560
Mailing Address - Fax:215-689-3495
Practice Address - Street 1:3502 SCOTTS LANE
Practice Address - Street 2:BUILDING 1 SUITE 114
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129
Practice Address - Country:US
Practice Address - Phone:267-847-9560
Practice Address - Fax:215-689-3495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016416261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)