Provider Demographics
NPI:1861415473
Name:DALE, JAMES ALEXANDER (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALEXANDER
Last Name:DALE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4403
Mailing Address - Country:US
Mailing Address - Phone:814-336-6308
Mailing Address - Fax:814-337-6067
Practice Address - Street 1:16269 CONNEAUT LAKE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3887
Practice Address - Country:US
Practice Address - Phone:814-336-1011
Practice Address - Fax:814-333-4428
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001636L103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA260048453OtherMEDICARE RAILROAD
PA070201Medicare ID - Type Unspecified