Provider Demographics
NPI:1720594633
Name:BAVERSO, STEPHANIE NICOLE VARGAS (LCSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:NICOLE VARGAS
Last Name:BAVERSO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 S BRADDOCK AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1881
Mailing Address - Country:US
Mailing Address - Phone:412-342-4058
Mailing Address - Fax:
Practice Address - Street 1:1789 S BRADDOCK AVE STE 410
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1881
Practice Address - Country:US
Practice Address - Phone:412-342-4058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0189331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical