Healthcare Provider Details

I. General information

NPI: 1770295651
Provider Name (Legal Business Name): MARY YAENO CARSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

6328 HOWE ST APT 22
PITTSBURGH PA
15206-4461
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-1000
  • Fax:
Mailing address:
  • Phone: 614-448-8920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: