Healthcare Provider Details

I. General information

NPI: 1619705647
Provider Name (Legal Business Name): JOAN SOULLIERE LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5333 BUTLER ST
PITTSBURGH PA
15201-2623
US

IV. Provider business mailing address

915 FARRAGUT ST
PITTSBURGH PA
15206-2203
US

V. Phone/Fax

Practice location:
  • Phone: 724-493-7067
  • Fax:
Mailing address:
  • Phone: 412-726-2415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW027685
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: