Provider Demographics
NPI:1366644494
Name:KOSTIUK-KUCZMA, MELISSA (MSED, NCC, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:KOSTIUK-KUCZMA
Suffix:
Gender:F
Credentials:MSED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:586 CHARLOTTE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-2415
Mailing Address - Country:US
Mailing Address - Phone:412-848-4566
Mailing Address - Fax:
Practice Address - Street 1:221 PENN AVE
Practice Address - Street 2:
Practice Address - City:WILKINSBURG
Practice Address - State:PA
Practice Address - Zip Code:15221-2118
Practice Address - Country:US
Practice Address - Phone:412-342-2373
Practice Address - Fax:412-247-6399
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004378101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAKO1949533OtherKEYSTONE HEALTH PLAN WEST