Provider Demographics
NPI:1447642194
Name:THE PROGRAMFOOFFENDERS
Entity type:Organization
Organization Name:THE PROGRAMFOOFFENDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VALERI
Authorized Official - Suffix:
Authorized Official - Credentials:04/28/2014
Authorized Official - Phone:412-535-4343
Mailing Address - Street 1:2410 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3019
Mailing Address - Country:US
Mailing Address - Phone:412-535-4343
Mailing Address - Fax:
Practice Address - Street 1:2410 5TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3019
Practice Address - Country:US
Practice Address - Phone:412-535-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007577261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health