Provider Demographics
NPI:1659581346
Name:DISANTIS, JAMES A (MSW,LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:DISANTIS
Suffix:
Gender:M
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-2940
Mailing Address - Country:US
Mailing Address - Phone:412-243-3400
Mailing Address - Fax:412-731-2684
Practice Address - Street 1:712 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-2940
Practice Address - Country:US
Practice Address - Phone:412-243-3400
Practice Address - Fax:412-731-2684
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0134221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000633848Medicare ID - Type UnspecifiedLCSW