Basic Information
Provider Information | |||||||||
NPI: | 1659613842 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PUSKAR | ||||||||
FirstName: | ALICIA | ||||||||
MiddleName: | H | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 420 | ||||||||
Address2: |   | ||||||||
City: | PERRYOPOLIS | ||||||||
State: | PA | ||||||||
PostalCode: | 154730420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7243171647 | ||||||||
FaxNumber: | 4126474486 | ||||||||
Practice Location | |||||||||
Address1: | 3200 S WATER ST | ||||||||
Address2: |   | ||||||||
City: | PITTSBURGH | ||||||||
State: | PA | ||||||||
PostalCode: | 152032307 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4124323600 | ||||||||
FaxNumber: | 4124323690 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/26/2013 | ||||||||
LastUpdateDate: | 02/09/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/11/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PS017312 | PA | N |   | Behavioral Health & Social Service Providers | Psychologist |   | 103TC0700X | PS017312 | PA | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TF0000X | PS017312 | PA | N |   | Behavioral Health & Social Service Providers | Psychologist | Family | 103G00000X | PS017312 | PA | Y |   | Behavioral Health & Social Service Providers | Clinical Neuropsychologist |   |
No ID Information.