=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457997090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATRINA MINK MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/19/2019
-----------------------------------------------------
Last Update Date | 11/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50 MONTGOMERY PL
-----------------------------------------------------
City | PITTSBURGH
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15212-5237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-529-4160
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1612 WEILER ST
-----------------------------------------------------
City | BRADDOCK
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15104-3062
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-651-0544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------