Organization
SEED IN THE SOOT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SANDRA H BANKS PH.D. (OWNER)
(412) 297-1514
Entity
Organization
Contact information
Practice address
2720 SHADY AVE, PITTSBURGH, PA 15217-2462
(412) 297-1514
(412) 945-5810
Mailing address
2720 SHADY AVE, PITTSBURGH, PA 15217-2462
(412) 297-1514
(412) 945-5810
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PS016487
PA
103T00000X
Psychologist
Primary
PS016487
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102219570 0002
—
PA
05
—
102317392 0001
—
PA
Enumeration date
07/14/2009
Last updated
05/01/2016
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