Provider Demographics
NPI:1457469645
Name:KOSTYAK, LINDA R (PH D)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:R
Last Name:KOSTYAK
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4716 ELLSWORTH AVENUE
Mailing Address - Street 2:SUITE 102 CATHERDAL MANSIONS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-621-9979
Mailing Address - Fax:412-621-9573
Practice Address - Street 1:4716 ELLSWORTH AVENUE
Practice Address - Street 2:SUITE 102 CATHERDAL MANSIONS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-621-9979
Practice Address - Fax:412-621-9573
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS009174L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000006395OtherUPMC HEALTH PLAN
PA1306225OtherHIGHMARK MAGELLAN
PAXXXXX7812OtherUNITED BEHAVIORAL HEALTH
PA01829885Medicaid
PA498471OtherVALUE OPTIONS HEALTH AMER
PA251878129OtherAETNA
P56090Medicare UPIN