Healthcare Provider Details

I. General information

NPI: 1124419569
Provider Name (Legal Business Name): KIM ANTONACCI-NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8606 LEXINGTON PL
WEXFORD PA
15090-7528
US

IV. Provider business mailing address

8235 OHIO RIVER BLVD
PITTSBURGH PA
15202-1454
US

V. Phone/Fax

Practice location:
  • Phone: 724-612-7606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC015838
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: