Provider Demographics
NPI:1194746446
Name:PSYCHOLOGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:PSYCHOLOGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:803-283-4004
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-0669
Mailing Address - Country:US
Mailing Address - Phone:803-283-4004
Mailing Address - Fax:803-283-4004
Practice Address - Street 1:114 WILLIAMS STREET
Practice Address - Street 2:CONNELLY BLDG STE 104
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720
Practice Address - Country:US
Practice Address - Phone:803-283-4004
Practice Address - Fax:803-283-4004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC262103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0294Medicaid
SCPS0040Medicaid