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Organization
PARKSIDE PSYCHOLOGICAL ASSOCIATES
Active
Organization
PARKSIDE PSYCHOLOGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AUDREY S SMITH M.A. (BUSINESS OWNER)
(814) 807-0861
Entity
Organization
Contact information
Practice address
435 CHESTNUT ST, MEADVILLE, PA 16335-4404
(814) 807-0861
(814) 807-0863
Mailing address
435 CHESTNUT ST, MEADVILLE, PA 16335-4404
(814) 807-0861
(814) 807-0863
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
103TC1900X
Counseling Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00182711
—
PA
05
—
1024120790006
—
PA
01
—
1205081221
GROUP NPI
—
01
—
1306866959
NPI
—
01
—
1316981590
NPI
—
01
—
462825
VALUE OPTIONS
PA
01
—
518561
VALUE OPTION
PA
Enumeration date
11/18/2008
Last updated
11/30/2020
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