Healthcare Provider Details

I. General information

NPI: 1619881455
Provider Name (Legal Business Name): GLADLY RARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SHERMAN AVE
PITTSBURGH PA
15212-4631
US

IV. Provider business mailing address

1301 SHERMAN AVE
PITTSBURGH PA
15212-4631
US

V. Phone/Fax

Practice location:
  • Phone: 201-978-3815
  • Fax: 213-693-1162
Mailing address:
  • Phone: 201-978-3815
  • Fax: 213-693-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: KIMBERLY POTTER
Title or Position: CLINICAL DIRECTOR
Credential: BCBA LBA LBS
Phone: 973-283-5821