Provider Demographics
NPI:1235948928
Name:LUISA A BONAVITA
Entity type:Organization
Organization Name:LUISA A BONAVITA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCINICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-445-4652
Mailing Address - Street 1:1370 OLD FREEPORT RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-4104
Mailing Address - Country:US
Mailing Address - Phone:412-417-9163
Mailing Address - Fax:
Practice Address - Street 1:1370 OLD FREEPORT RD STE 2B
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-4104
Practice Address - Country:US
Practice Address - Phone:412-417-9163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty