MEDICARE: CECELIA A STACK MED

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

General Provider Information

NPI Number	:	1407020332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CECELIA A STACK MED

Provider Business Mailing Address
First Line	:	332 FIFTH AVE
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15132-2633
Country	:	US
Telephone Number	:	412-675-8533
Fax Number	:	412-675-8920

Provider Business Practice Location Address
First Line	:	332 FIFTH AVE
Second Line	:
City	:	MCKEESPORT
State	:	PA
Zip	:	15132-2633
Country	:	US
Telephone Number	:	412-675-8533
Fax Number	:	412-675-8920

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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1306841408 — DR. HOWARD MARK ELSON D.M.D.
Practice Location Address:

332 5TH AVE
MCKEESPORT, PA
15132-2633

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1518003870 — DR. HOWARD M. ELSON
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1154595080 — KEVIN MCCULLOUGH
Practice Location Address:

332 FIFTH AVE , SUITE 214
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1083888911 — DAVID JAY DORFIELD
Practice Location Address:

332 FIFTH AVE
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15132-2633

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1144459124 — KEVIN JOSEPH CARL M.D.
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1043214000 — MRS. ISABEL R AURE MD
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Directions to “ CECELIA A STACK MED” Practice Location

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