Provider Demographics
NPI:1790178812
Name:KAREN DEKLEVA REBOTTINI
Entity Type:Organization
Organization Name:KAREN DEKLEVA REBOTTINI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEKLEVA REBOTTINI
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED PSYCHOLOGIS
Authorized Official - Phone:724-733-8313
Mailing Address - Street 1:6219 WELLESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1724
Mailing Address - Country:US
Mailing Address - Phone:412-362-7970
Mailing Address - Fax:412-362-7970
Practice Address - Street 1:4047 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1846
Practice Address - Country:US
Practice Address - Phone:724-733-8313
Practice Address - Fax:724-733-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003084L103TC0700X
PAPS017382103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty