Provider Demographics
NPI:1558319525
Name:STEVICK, EMILY L
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:L
Last Name:STEVICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15216-1242
Mailing Address - Country:US
Mailing Address - Phone:412-343-1225
Mailing Address - Fax:412-343-1225
Practice Address - Street 1:260 MORRISON DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-1242
Practice Address - Country:US
Practice Address - Phone:412-343-1225
Practice Address - Fax:412-343-1225
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002917L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARO6553Medicare UPIN
PA191236Medicare ID - Type UnspecifiedPROVIDER NUMBER