Healthcare Provider Details

I. General information

NPI: 1316767866
Provider Name (Legal Business Name): DEREK ANDREW STOTSKY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 GREENVILLE RD
MERCER PA
16137-5070
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-662-2650
  • Fax: 724-662-1338
Mailing address:
  • Phone: 724-662-2650
  • Fax: 724-662-1338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC003622
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003622
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: