Healthcare Provider Details

I. General information

NPI: 1881331262
Provider Name (Legal Business Name): VINCENT ALDAZABAL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2022
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 SHAW AVE FL 2
MCKEESPORT PA
15132-2918
US

IV. Provider business mailing address

331 SHAW AVE FL 2
MCKEESPORT PA
15132-2918
US

V. Phone/Fax

Practice location:
  • Phone: 412-316-6002
  • Fax:
Mailing address:
  • Phone: 412-316-6002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW139104
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: