Organization
CENTERVILLE CLINICS, INC. PSY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PATRICIA MARTOS (DIRECTOR FIINANCE AND PERSONNEL)
(724) 632-6801
Entity
Organization
Contact information
Practice address
190 BONAR AVE, WAYNESBURG, PA 15370-1604
(724) 627-8156
Mailing address
1070 OLD NATIONAL PIKE, FREDERICKTOWN, PA 15333-2114
(724) 632-6801
(724) 632-6312
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007288440088
—
PA
01
—
1804928
HIGHMARK BLUE SHIELD
PA
01
—
328834A336348
VALUE BEHAVIORAL HEALTH
PA
Enumeration date
04/23/2008
Last updated
04/23/2008
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