Provider Demographics
NPI:1730257544
Name:PETRICK, JAMES DOUGLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DOUGLAS
Last Name:PETRICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:650 WASHINGTON RD
Mailing Address - Street 2:STE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2702
Mailing Address - Country:US
Mailing Address - Phone:304-296-8846
Mailing Address - Fax:412-561-6508
Practice Address - Street 1:650 WASHINGTON RD
Practice Address - Street 2:STE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15228-2702
Practice Address - Country:US
Practice Address - Phone:412-561-6506
Practice Address - Fax:412-561-6508
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPS007044L103G00000X
WV578103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist