Provider Demographics
NPI:1548300700
Name:YAQUINTO, GARY D (LIC PSYCHOLOGIST)
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:YAQUINTO
Suffix:
Gender:M
Credentials:LIC PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 LADDIE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-1333
Mailing Address - Country:US
Mailing Address - Phone:724-228-4986
Mailing Address - Fax:
Practice Address - Street 1:272 LADDIE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-1333
Practice Address - Country:US
Practice Address - Phone:724-228-4986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004640-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAYA517259OtherHIGHMARK PROVIDER NUMBER