Provider Demographics
NPI:1982958393
Name:MASTANTUONO, KATHLEEN GERTRUDE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GERTRUDE
Last Name:MASTANTUONO
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 1:1200 REEDSDALE STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15233-2108
Mailing Address - Country:US
Mailing Address - Phone:412-697-2021
Mailing Address - Fax:412-697-3414
Practice Address - Street 1:1200 REEDSDALE ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15233-2109
Practice Address - Country:US
Practice Address - Phone:412-697-2021
Practice Address - Fax:412-697-3414
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0174281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical