NPIMap

Organization Active NPI

Sanderson Psychological, LLC

  • Community/Behavioral Health Agency
  • Elizabeth, PA
National Provider Identifier
1699212431
Registry record updated May 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
PS018190 Issued in PA
Legal business name
SANDERSON PSYCHOLOGICAL, LLC
Practice address
95 Enterprise St
Suite 104
Elizabeth, PA 15037-2070
Phone
(412) 370-4848
Fax
(412) 754-2006
NPI assigned
Jan 31, 2017
Last updated
May 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brooke Nicole Sanderson, PSY.D.NPI 1871842591
Title
President
Phone
(412) 370-4848

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X PS018190 PA Primary
Community/Behavioral Health Agency 251S00000X PC006524 PA

Addresses

Primary practice location

95 Enterprise St
Suite 104
Elizabeth, PA 15037-2070

Mailing address

95 Enterprise St
Suite 104
Elizabeth, PA 15037-2070
Phone (412) 370-4848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170822003793 PA Part B Supplier - Clinic/Group Practice 0941572184 Receives reassigned benefits from 19 practitioners
Practice locations: Elizabeth, PA

National Provider Directory

National Provider Directory

Locations

95 Enterprise St
Ste 104
Elizabeth, PA 15037
Phone (412) 754-1100

50 Berry Rd
Ste 1
Washington, PA 15301
Phone (412) 254-4353

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1699212431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 ENTERPRISE ST",
            "address_2": "SUITE 104",
            "city": "ELIZABETH",
            "state": "PA",
            "postal_code": "150372070",
            "telephone_number": "412-370-4848",
            "fax_number": "412-754-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 ENTERPRISE ST",
            "address_2": "SUITE 104",
            "city": "ELIZABETH",
            "state": "PA",
            "postal_code": "150372070",
            "telephone_number": "412-370-4848",
            "fax_number": "412-754-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDERSON PSYCHOLOGICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-31",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "SANDERSON",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "412-370-4848",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "PS018190",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "PC006524",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabeth, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.