Provider Demographics
NPI:1225673577
Name:PARADISE, RUSTIN (MS, LPC)
Entity Type:Individual
Prefix:
First Name:RUSTIN
Middle Name:
Last Name:PARADISE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 MEADOW LN UNIT 303
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-4743
Mailing Address - Country:US
Mailing Address - Phone:814-494-1313
Mailing Address - Fax:
Practice Address - Street 1:3501 FORBES AVE STE 900
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3326
Practice Address - Country:US
Practice Address - Phone:412-246-6156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional