Provider Demographics
NPI:1033004841
Name:ANTENUCCI, MARIAH MARCELLA (MS, NCC LAPC)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:MARCELLA
Last Name:ANTENUCCI
Suffix:
Gender:F
Credentials:MS, NCC LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ACADEMY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1462
Mailing Address - Country:US
Mailing Address - Phone:412-780-0107
Mailing Address - Fax:
Practice Address - Street 1:1501 POTOMAC AVE # 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15216-2135
Practice Address - Country:US
Practice Address - Phone:412-388-0880
Practice Address - Fax:412-388-1880
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC000779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty