Provider Demographics
NPI:1538322276
Name:IMPAVIDO, JOHN ANDREW SR (MED LPC CAC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANDREW
Last Name:IMPAVIDO
Suffix:SR
Gender:M
Credentials:MED LPC CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EAST OHIO ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-303-2750
Mailing Address - Fax:412-487-9830
Practice Address - Street 1:250 EAST OHIO ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212
Practice Address - Country:US
Practice Address - Phone:412-303-2750
Practice Address - Fax:412-487-9830
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001735104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker