Provider Demographics
NPI:1720262058
Name:DALZELL, GEORGE E (LCSW)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:DALZELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1626
Mailing Address - Country:US
Mailing Address - Phone:412-441-9786
Mailing Address - Fax:412-363-2375
Practice Address - Street 1:5150 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1626
Practice Address - Country:US
Practice Address - Phone:412-441-9786
Practice Address - Fax:412-363-2375
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015639101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACW015639OtherSTATE LICENSE