=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164288981
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHANNA BELAKO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2024
-----------------------------------------------------
Last Update Date | 02/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3319 BROWNSVILLE RD
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15227-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-141-2882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2009 HANKINS DR
-----------------------------------------------------
City | MCKEESPORT
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15135-3046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-720-0005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | SW141265
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------