Provider Demographics
NPI:1356354740
Name:BACK, RONNA P (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RONNA
Middle Name:P
Last Name:BACK
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 1:302 FOX CHAPEL RD APT 415
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-2337
Mailing Address - Country:US
Mailing Address - Phone:412-682-6046
Mailing Address - Fax:412-731-1607
Practice Address - Street 1:414 ALLEGHENY RIVER BLVD
Practice Address - Street 2:VILLAGE SQUARE, SUITE 204
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1735
Practice Address - Country:US
Practice Address - Phone:412-682-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW003576L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABA648988Medicare ID - Type Unspecified