Provider Demographics
NPI:1124380878
Name:PETRELLI, SHANE
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:PETRELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 BINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1101
Mailing Address - Country:US
Mailing Address - Phone:412-235-5400
Mailing Address - Fax:
Practice Address - Street 1:261 ROSECREST DR
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-4041
Practice Address - Country:US
Practice Address - Phone:412-829-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health