MEDICARE: MARIAH MARCELLA ANTENUCCI MS, NCC LAPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	APC000779	PA

General Provider Information

NPI Number	:	1033004841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAH MARCELLA ANTENUCCI MS, NCC LAPC

Provider Business Mailing Address
First Line	:	28 ACADEMY AVE APT 2
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-1462
Country	:	US
Telephone Number	:	412-780-0107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 POTOMAC AVE # 200
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2135
Country	:	US
Telephone Number	:	412-388-0880
Fax Number	:	412-388-1880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2025
Last Update Date	:	06/11/2025

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