Provider Demographics
NPI:1831708577
Name:SEVERE, KARISA LEE MAUTHE (MA, NCC, CAADC)
Entity type:Individual
Prefix:
First Name:KARISA
Middle Name:LEE MAUTHE
Last Name:SEVERE
Suffix:
Gender:F
Credentials:MA, NCC, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 BRODHEAD RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2322
Mailing Address - Country:US
Mailing Address - Phone:412-320-5067
Mailing Address - Fax:
Practice Address - Street 1:1010 BRODHEAD RD STE 2
Practice Address - Street 2:
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-2322
Practice Address - Country:US
Practice Address - Phone:412-339-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012719101YP2500X
PA13611101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)