MEDICARE: MENTAL FITNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW017900	PA

General Provider Information

NPI Number	:	1316450315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENTAL FITNESS, LLC

Provider Business Mailing Address
First Line	:	276 OAKVILLE RD
Second Line	:
City	:	BEAVER FALLS
State	:	PA
Zip	:	15010-1210
Country	:	US
Telephone Number	:	412-334-9790
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 MACKENZIE WAY STE 100
Second Line	:
City	:	CRANBERRY TOWNSHIP
State	:	PA
Zip	:	16066-5338
Country	:	US
Telephone Number	:	412-334-9790
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEPHEN THOMAS WIZE
Credential	:	LCSW
Telephone Number	:	412-334-9790

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	11/13/2017

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