Basic Information
| Provider Information | |||||||||
| NPI: | 1679574503 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINDMARSH | ||||||||
| FirstName: | DALE | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 766 E. PITTSBURGH ST. | ||||||||
| Address2: | CHESTNUT RIDGE COUNSELING SERVICES, INC | ||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244370729 | ||||||||
| FaxNumber: | 7244372761 | ||||||||
| Practice Location | |||||||||
| Address1: | 766E. PITTSBURGH ST. | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 156012678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244370729 | ||||||||
| FaxNumber: | 7244372761 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | MD022910E | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 0007326390012 | 05 | PA | MEDICAID | 2316032 | 05 | OH | MEDICAID |