Provider Demographics
NPI:1386784593
Name:THE PENNSYLVANIA STATE UNIVERSITY
Entity type:Organization
Organization Name:THE PENNSYLVANIA STATE UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:HOLSING
Authorized Official - Suffix:
Authorized Official - Credentials:CPB, CPMA
Authorized Official - Phone:814-863-2680
Mailing Address - Street 1:337 MOORE BUILDING
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-3103
Mailing Address - Country:US
Mailing Address - Phone:814-865-2191
Mailing Address - Fax:814-863-1331
Practice Address - Street 1:337 MOORE BUILDING
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-3103
Practice Address - Country:US
Practice Address - Phone:814-865-2191
Practice Address - Fax:814-863-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 2084P0800X
PA327550251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100270742-0042Medicaid
PA75990OtherEVERNORTH/CIGNA
PA100270742-0041Medicaid
PA1997358OtherHIGHMARK BLUE SHIELD
PA50003816OtherCAPITAL BLUE CROSS
PA1000740OtherCOMMUNITY CARE BEHAVIORAL HEALTH
PA327488OtherEMPIRE BLUE CROSS BLUE SHIELD
PA50003816OtherCAPITAL BLUE CROSS
PA1002707420006Medicaid