Provider Demographics
NPI:1699117481
Name:WESTERN PSYCHIATRIC INSTITUTE AND CLINIC
Entity type:Organization
Organization Name:WESTERN PSYCHIATRIC INSTITUTE AND CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:POLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-246-5619
Mailing Address - Street 1:100 N BELLEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 N BELLEFIELD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2600
Practice Address - Country:US
Practice Address - Phone:412-246-5619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129836261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health