BETH WALLACH MA PSYCHOLOGIST LLC NPI 1285762336

NPI Information

  • NPI: 1285762336
  • Provider Name: BETH WALLACH, MA, PSYCHOLOGIST, LLC
  • Classification: Clinic/Center - 261QM0850X
  • Specialization: Adult Mental Health
  • Entity Type: Organization
  • Former Legal Business Name: ELIZABETH WALLACH, MA, PSYCHOLOGIST
  • Address: 1061 WATERDAM PLAZA DR STE 208
    CANONSBURG, PA
    ZIP 15317
  • Phone: (724) 413-4991

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NPI Details

BETH WALLACH, MA, PSYCHOLOGIST, LLC is an adult mental health clinic center in Canonsburg, PA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. BETH WALLACH, MA, PSYCHOLOGIST, LLC NPI is 1285762336. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Elizabeth Wallach, Ma, Psychologist.

The provider's business location address is:

1061 WATERDAM PLAZA DR STE 208
CANONSBURG, PA
ZIP 15317-408
Phone: (724) 413-4991
Fax: (724) 260-0221

The provider's authorized official is Elizabeth Wallach .
The authorized official title is Psychologist and has the following contact phone number (724) 413-4991.

The enumeration date for this NPI number is 3/1/2007 and was last updated on 2/10/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103T00000XPsychologistPS6340LPENNSYLVANIANo
2261QM0850XClinic/CenterAdult Mental HealthYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1001523992001MEDICAIDPENNSYLVANIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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