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General NPI Number Information
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NPI Number | 1619107125
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Entity Type | Individual
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Provider Name | AMIE LYNN CHULACK LSW
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Gender | Female
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Dates
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Enumeration Date | 07/17/2009
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Last Update Date | 07/17/2009
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Provider Practice Location Address
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Address Line | 3501 FORBES AVE SUITE 900
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City | PITTSBURGH
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State | PA
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Zip | 15213-3317
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Country | US
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Telephone | 412-246-5945
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Fax |
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Provider Business Mailing Address
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Address Line | 630 CLYDE ST APT 201
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City | PITTSBURGH
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State | PA
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Zip | 15213-2932
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Country | US
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Telephone | 412-551-6569
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW-012587-L
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License Number State | PA
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