Provider Demographics
NPI:1003323841
Name:SOTO, TANJA THERESIA (LPC, BCBA)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:THERESIA
Last Name:SOTO
Suffix:
Gender:F
Credentials:LPC, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 4TH AVE STE 1801
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1716
Mailing Address - Country:US
Mailing Address - Phone:833-274-4325
Mailing Address - Fax:
Practice Address - Street 1:1235 PENN AVE STE 206
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2100
Practice Address - Country:US
Practice Address - Phone:610-374-4963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003193101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor