Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PC002229 | PA |
Y | 103T00000X | Psychologist | PC002229 | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PC002229 | PA |
N | 103TC1900X | Counseling Psychologist | PC002229 | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PC002229 | PA |
N | 103TF0000X | Family Psychologist | MF000231 | PA |
N | 103TH0004X | Health Psychologist | PC002229 | PA |
N | 103TP2701X | Group Psychotherapist | PC002229 | PA |
N | 103TS0200X | School Psychologist | PC002229 | PA |
NPI | 1013242148 |
---|---|
Provider Name | Dr. Joe Martin Utay |
First Address | Wexford, PA 15090-8394 |
Second Address | Wexford, PA 15090-8394 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2009 |
Last Update Date | 07/10/2009 |