Basic Information
| Provider Information | |||||||||
| NPI: | 1114440765 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESTFINO | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MSCP, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4028 HOOSAC ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152071131 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1800 WEST ST FL 4 | ||||||||
| Address2: | |||||||||
| City: | HOMESTEAD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 151202563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124644781 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 07/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YS0200X | N | Behavioral Health & Social Service Providers | Counselor | School | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.