Provider Demographics
NPI:1619598752
Name:GAVASTO, MISTY (MSED)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:GAVASTO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 OHIO RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:EMSWORTH
Mailing Address - State:PA
Mailing Address - Zip Code:15202-1594
Mailing Address - Country:US
Mailing Address - Phone:412-766-4030
Mailing Address - Fax:
Practice Address - Street 1:8235 OHIO RIVER BLVD
Practice Address - Street 2:
Practice Address - City:EMSWORTH
Practice Address - State:PA
Practice Address - Zip Code:15202-1594
Practice Address - Country:US
Practice Address - Phone:412-789-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)