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General NPI Number Information
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NPI Number | 1902148562
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Entity Type | Organization
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Legal Business Name | DEPARMENT OF VETERANS AFFAIRS
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 1010 DELAFIELD RD 130P-A
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City | PITTSBURGH
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State | PA
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Zip | 15215-1802
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Country | US
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Telephone | 412-822-2412
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Fax | 412-822-2313
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Provider Business Mailing Address
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Address Line | 1010 DELAFIELD RD 130P-A
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City | PITTSBURGH
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State | PA
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Zip | 15215-1802
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Country | US
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Telephone | 412-822-2412
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Fax | 412-822-2313
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Authorized Official
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Title or Position | ASSISTANT CHIEF OF SOCIAL WORK
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Name | MISS MISTY SHIELDS
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Credential | LCSW
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Telephone | 412-822-2363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QV0200X
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Taxonomy Name | VA Clinic/Center
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License Number | SW130267
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License Number State | PA
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