Healthcare Provider Details

I. General information

NPI: 1750299467
Provider Name (Legal Business Name): LISA ROTELLO LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 OLD WASHINGTON RD STE AND250
PITTSBURGH PA
15241-2524
US

IV. Provider business mailing address

1318 MEADOWBROOK DR
CANONSBURG PA
15317-5029
US

V. Phone/Fax

Practice location:
  • Phone: 412-634-5969
  • Fax: 412-532-9767
Mailing address:
  • Phone: 412-634-5969
  • Fax: 412-532-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW01273L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: