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General NPI Number Information
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NPI Number | 1447642194
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Entity Type | Organization
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Legal Business Name | THE PROGRAMFOOFFENDERS
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 2410 5TH AVE
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City | PITTSBURGH
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State | PA
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Zip | 15213-3019
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Country | US
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Telephone | 412-535-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 5TH AVE
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City | PITTSBURGH
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State | PA
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Zip | 15213-3019
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Country | US
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Telephone | 412-535-4343
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR
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Name | DOMINIC VALERI
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Credential | 04/28/2014
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Telephone | 412-535-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | PC007577
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License Number State | PA
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