Provider Demographics
NPI:1831459023
Name:VIDAK, REBECCA KOSTURA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:KOSTURA
Last Name:VIDAK
Suffix:
Gender:F
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 1:6425 INTERLAKEN DR
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-3557
Mailing Address - Country:US
Mailing Address - Phone:412-427-0497
Mailing Address - Fax:
Practice Address - Street 1:4150 WASHINGTON RD
Practice Address - Street 2:GROUND FLOOR ROOM 2
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-2534
Practice Address - Country:US
Practice Address - Phone:412-427-0497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0150581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical