Healthcare Provider Details

I. General information

NPI: 1710659875
Provider Name (Legal Business Name): STEPHANIE I PERGANTIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S WALNUT LN STE 101&201
BEAVER PA
15009-1739
US

IV. Provider business mailing address

28 FRIDAY RD
PITTSBURGH PA
15209-2162
US

V. Phone/Fax

Practice location:
  • Phone: 412-888-3317
  • Fax:
Mailing address:
  • Phone: 412-848-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0013810
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: