Healthcare Provider Details

I. General information

NPI: 1336997121
Provider Name (Legal Business Name): SAM DOUGLAS CAURDY MSCP, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WATERDAM PLAZA DR STE 240
CANONSBURG PA
15317-5411
US

IV. Provider business mailing address

139 SCOTT LN
VENETIA PA
15367-1115
US

V. Phone/Fax

Practice location:
  • Phone: 412-219-7378
  • Fax:
Mailing address:
  • Phone: 810-844-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018768
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: