Provider Demographics
NPI:1467840728
Name:VASILATOS, DENI (MA, ATR-BC, LPC)
Entity Type:Individual
Prefix:
First Name:DENI
Middle Name:
Last Name:VASILATOS
Suffix:
Gender:M
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SEBRING RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-9387
Mailing Address - Country:US
Mailing Address - Phone:724-774-3221
Mailing Address - Fax:
Practice Address - Street 1:2009 MACKENZIE WAY
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5332
Practice Address - Country:US
Practice Address - Phone:724-814-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health