Provider Demographics
NPI:1528007895
Name:PISANO, MARY JO (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JO
Last Name:PISANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5850 ELLSWORTH AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1775
Mailing Address - Country:US
Mailing Address - Phone:412-661-2036
Mailing Address - Fax:412-422-8807
Practice Address - Street 1:5850 ELLSWORTH AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1775
Practice Address - Country:US
Practice Address - Phone:412-661-2036
Practice Address - Fax:412-422-8807
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003176-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA135513OtherHIGHMARK PROVIDER #