Provider Demographics
NPI:1730412297
Name:COMPREHENSIVE COUNSELING AND ASESSEMENT SE
Entity type:Organization
Organization Name:COMPREHENSIVE COUNSELING AND ASESSEMENT SE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:AQUALINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:724-853-4501
Mailing Address - Street 1:132 SOUTH MAIN STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-853-4501
Mailing Address - Fax:724-853-4504
Practice Address - Street 1:132 SOUTH MAIN STREET
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-853-4501
Practice Address - Fax:724-853-4504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0133821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA260622Medicare UPIN