Healthcare Provider Details

I. General information

NPI: 1700245875
Provider Name (Legal Business Name): LAURA CHARLESWORTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WALNUT ST
MCKEESPORT PA
15132-2801
US

IV. Provider business mailing address

500 WALNUT ST
MCKEESPORT PA
15132-2801
US

V. Phone/Fax

Practice location:
  • Phone: 412-675-8530
  • Fax: 412-675-8920
Mailing address:
  • Phone: 412-675-8530
  • Fax: 412-675-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010690
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

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: