Healthcare Provider Details

I. General information

NPI: 1245999689
Provider Name (Legal Business Name): BEVERLY GAETANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 SUNSET CIR
CRANBERRY TOWNSHIP PA
16066-6722
US

IV. Provider business mailing address

716 SUNSET CIR
CRANBERRY TOWNSHIP PA
16066-6722
US

V. Phone/Fax

Practice location:
  • Phone: 412-983-4714
  • Fax:
Mailing address:
  • Phone: 412-983-4714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019318
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: