Provider Demographics
NPI:1487422382
Name:EMBODY THERAPY
Entity type:Organization
Organization Name:EMBODY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNDER/LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTELLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-312-6035
Mailing Address - Street 1:675 VALLEYVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1015
Mailing Address - Country:US
Mailing Address - Phone:412-312-6035
Mailing Address - Fax:
Practice Address - Street 1:1725 WASHINGTON RD STE 602
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-1215
Practice Address - Country:US
Practice Address - Phone:412-312-6035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-20
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1659798205Medicaid