=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720454663
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOAN FALTOT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2015
-----------------------------------------------------
Last Update Date | 08/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 272 E CONNELLY BLVD
-----------------------------------------------------
City | SHARON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16146-1852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-983-1131
-----------------------------------------------------
Fax | 724-983-1387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1795 BEND RD
-----------------------------------------------------
City | MERCER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16137-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-866-1206
-----------------------------------------------------
Fax | 724-983-1387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PC 008341
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------