Provider Demographics
NPI:1336537323
Name:JURECKO, ROGNA (MED, MA, LPC)
Entity Type:Individual
Prefix:
First Name:ROGNA
Middle Name:
Last Name:JURECKO
Suffix:
Gender:F
Credentials:MED, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 EMERYVILLE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-5015
Mailing Address - Country:US
Mailing Address - Phone:412-921-3908
Mailing Address - Fax:412-927-0578
Practice Address - Street 1:144 EMERYVILLE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-5015
Practice Address - Country:US
Practice Address - Phone:412-921-3908
Practice Address - Fax:412-927-0578
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007714101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty