Provider Demographics
NPI: | 1538415856 |
---|---|
Name: | MARSTON PSYCHOLOGICAL SERVICES |
Entity type: | Organization |
Organization Name: | MARSTON PSYCHOLOGICAL SERVICES |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | LICENSED PSYCHOLOGIST/OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DANIEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MARSTON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD |
Authorized Official - Phone: | 412-380-2695 |
Mailing Address - Street 1: | 222 SPARTAN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | MONROEVILLE |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15146-1526 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 412-380-2695 |
Mailing Address - Fax: | 412-380-0150 |
Practice Address - Street 1: | 12320 ROUTE 30 STE 2 |
Practice Address - Street 2: | |
Practice Address - City: | NORTH HUNTINGDON |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15642-2590 |
Practice Address - Country: | US |
Practice Address - Phone: | 412-380-2695 |
Practice Address - Fax: | 412-380-0150 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-07-24 |
Last Update Date: | 2012-07-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Single Specialty |