Provider Demographics
NPI:1417015470
Name:GOTH, GINA MARIE (MED,CAC,LPC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:GOTH
Suffix:
Gender:F
Credentials:MED,CAC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 EVANDALE DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-2813
Mailing Address - Country:US
Mailing Address - Phone:412-361-8020
Mailing Address - Fax:
Practice Address - Street 1:401 SHADY AVE
Practice Address - Street 2:104 B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-4409
Practice Address - Country:US
Practice Address - Phone:412-361-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional