Healthcare Provider Details

I. General information

NPI: 1457469645
Provider Name (Legal Business Name): LINDA R KOSTYAK PH D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4716 ELLSWORTH AVENUE SUITE 102 CATHERDAL MANSIONS
PITTSBURGH PA
15213
US

IV. Provider business mailing address

4716 ELLSWORTH AVENUE SUITE 102 CATHERDAL MANSIONS
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-621-9979
  • Fax: 412-621-9573
Mailing address:
  • Phone: 412-621-9979
  • Fax: 412-621-9573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS009174L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: