Healthcare Provider Details

I. General information

NPI: 1831708577
Provider Name (Legal Business Name): KARISA LEE MAUTHE SEVERE MA, NCC, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2020
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 BRODHEAD RD STE 2
MOON TOWNSHIP PA
15108-2322
US

IV. Provider business mailing address

1010 BRODHEAD RD
MOON TOWNSHIP PA
15108-2322
US

V. Phone/Fax

Practice location:
  • Phone: 412-339-1782
  • Fax:
Mailing address:
  • Phone: 412-320-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC012719
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13611
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: