Provider Demographics
NPI:1053601104
Name:PAGE, EDWARD J (PHD, BCBA-D)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:J
Last Name:PAGE
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1236 OLD CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-4841
Mailing Address - Country:US
Mailing Address - Phone:724-554-6185
Mailing Address - Fax:
Practice Address - Street 1:1236 OLD CONCORD RD
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4841
Practice Address - Country:US
Practice Address - Phone:724-554-6185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst