Healthcare Provider Details

I. General information

NPI: 1720004005
Provider Name (Legal Business Name): STEPHEN A. GOSTOWSKI M.A., L.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 REEDSDALE STREET
PITTSBURGH PA
15233
US

IV. Provider business mailing address

1200 REEDSDALE STREET
PITTSBURGH PA
15233
US

V. Phone/Fax

Practice location:
  • Phone: 412-323-4543
  • Fax: 412-323-4507
Mailing address:
  • Phone: 412-323-4543
  • Fax: 412-323-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP5006931L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: