Healthcare Provider Details

I. General information

NPI: 1053317586
Provider Name (Legal Business Name): ELIZABETH LEE FOGARTY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 4TH AVE STE 300
PITTSBURGH PA
15222-2120
US

IV. Provider business mailing address

307 4TH AVE STE 300
PITTSBURGH PA
15222-2120
US

V. Phone/Fax

Practice location:
  • Phone: 412-391-1816
  • Fax: 412-391-6640
Mailing address:
  • Phone: 412-391-1816
  • Fax: 412-391-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS002228L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS002228L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: