Provider Demographics
NPI:1982271912
Name:STACHOWIAK, ERIC SAMUEL (LSW, MSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SAMUEL
Last Name:STACHOWIAK
Suffix:
Gender:M
Credentials:LSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BLAZIER DR STE 400
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9508
Mailing Address - Country:US
Mailing Address - Phone:412-330-5857
Mailing Address - Fax:
Practice Address - Street 1:500 BLAZIER DR STE 400
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9508
Practice Address - Country:US
Practice Address - Phone:724-934-2420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132909101YM0800X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health