Provider Demographics
NPI:1720004005
Name:GOSTOWSKI, STEPHEN A (MA, LP)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:GOSTOWSKI
Suffix:
Gender:M
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 REEDSDALE STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233
Mailing Address - Country:US
Mailing Address - Phone:412-323-4543
Mailing Address - Fax:412-323-4507
Practice Address - Street 1:1200 REEDSDALE STREET
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233
Practice Address - Country:US
Practice Address - Phone:412-323-4543
Practice Address - Fax:412-323-4507
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAP5006931L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
489576OtherHIGHMARK