Provider Demographics
NPI:1225443872
Name:GOOZDICH, RUTHANN (LPC)
Entity Type:Individual
Prefix:
First Name:RUTHANN
Middle Name:
Last Name:GOOZDICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SCENIC RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:VENETIA
Mailing Address - State:PA
Mailing Address - Zip Code:15367-2342
Mailing Address - Country:US
Mailing Address - Phone:724-255-8801
Mailing Address - Fax:
Practice Address - Street 1:565 NATIONAL PIKE W
Practice Address - Street 2:SUITE 2
Practice Address - City:BROWNSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15417-9221
Practice Address - Country:US
Practice Address - Phone:724-255-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007663101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional