Healthcare Provider Details

I. General information

NPI: 1902476427
Provider Name (Legal Business Name): LIGIA DANITSA ANTEZANA PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

V. Phone/Fax

Practice location:
  • Phone: 412-246-6262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020014
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: