=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750741658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NEDWARD PROSTEJOVSKY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2016
-----------------------------------------------------
Last Update Date | 03/04/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 129 WINDY VALLEY RD
-----------------------------------------------------
City | EBENSBURG
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15931-4926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-472-8891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 441 BRICK RD
-----------------------------------------------------
City | LORETTO
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15940-7409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 327900
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------