Provider Demographics
NPI:1174809198
Name:PUNGRATZ, TODD (LCSW, CAADC)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:PUNGRATZ
Suffix:
Gender:M
Credentials:LCSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1309
Mailing Address - Country:US
Mailing Address - Phone:412-621-4757
Mailing Address - Fax:412-621-9784
Practice Address - Street 1:4111 PENN AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1305
Practice Address - Country:US
Practice Address - Phone:855-874-7763
Practice Address - Fax:866-920-9559
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA9662101YA0400X
PACW0177871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)