Provider Demographics
NPI:1396851697
Name:DETORE, ANTHONY ARTHUR (EDD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ARTHUR
Last Name:DETORE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:DR
Other - First Name:LANNY
Other - Middle Name:
Other - Last Name:DETORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EDD
Mailing Address - Street 1:230 WEST PITTSBURGH STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-834-8783
Mailing Address - Fax:724-834-4439
Practice Address - Street 1:230 WEST PITTSBURGH STREET
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-834-8783
Practice Address - Fax:724-834-4439
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002552L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA420230OtherHIGHMARK
PADE0420230Medicaid
PA202620OtherUPMC
0420230Medicare UPIN
PADE0420230Medicaid