Provider Demographics
NPI:1427264407
Name:PSYCHOTHERAPY SERVICES OF CRANBERRY, P.C.
Entity type:Organization
Organization Name:PSYCHOTHERAPY SERVICES OF CRANBERRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:724-776-5690
Mailing Address - Street 1:215 EXECUTIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6406
Mailing Address - Country:US
Mailing Address - Phone:724-776-5690
Mailing Address - Fax:724-776-5611
Practice Address - Street 1:215 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6406
Practice Address - Country:US
Practice Address - Phone:724-776-5690
Practice Address - Fax:724-776-5611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003621-L251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA058172 A796230OtherVBH-PA
PA41-01834802Medicaid