Provider Demographics
NPI:1861950420
Name:CENTER FOR CHILD AND ADULT PSYCHIATRY LLC
Entity type:Organization
Organization Name:CENTER FOR CHILD AND ADULT PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:THORKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-632-0172
Mailing Address - Street 1:1911 MONONGAHELA AVE UNIT 82661
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-6616
Mailing Address - Country:US
Mailing Address - Phone:330-632-0173
Mailing Address - Fax:
Practice Address - Street 1:2909 W BAY TO BAY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8100
Practice Address - Country:US
Practice Address - Phone:813-995-1775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295225597OtherNATIONAL PLAN & PROVIDER ENUMERATION SYSTEM