Provider Demographics
NPI:1518387091
Name:SHUTOK-LEROY, LINDA CAROL (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:CAROL
Last Name:SHUTOK-LEROY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-2485
Mailing Address - Country:US
Mailing Address - Phone:724-514-7256
Mailing Address - Fax:724-514-7256
Practice Address - Street 1:540 DELWAR RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-1309
Practice Address - Country:US
Practice Address - Phone:412-737-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20-3322716101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty