Provider Demographics
NPI:1386842094
Name:MAZEFSKY, CARLA A (PHD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:A
Last Name:MAZEFSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:DISALVO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 LOTHROP ST
Mailing Address - Street 2:FORBES TOWER, SUITE 9055
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-2536
Mailing Address - Country:US
Mailing Address - Phone:412-647-3087
Mailing Address - Fax:412-647-4486
Practice Address - Street 1:3420 5TH AVE
Practice Address - Street 2:ROOM 236
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3205
Practice Address - Country:US
Practice Address - Phone:412-692-5589
Practice Address - Fax:412-692-5679
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016199103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA113482EBOMedicare PIN