Provider Demographics
NPI:1033396395
Name:WOZNIAK, JACK (MED, CAC, LPC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:WOZNIAK
Suffix:
Gender:M
Credentials:MED, CAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4117 LIBERTY AVE
Mailing Address - Street 2:DRAKE ANNEX
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1446
Mailing Address - Country:US
Mailing Address - Phone:412-586-2575
Mailing Address - Fax:
Practice Address - Street 1:4117 LIBERTY AVE
Practice Address - Street 2:DRAKE ANNEX
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1446
Practice Address - Country:US
Practice Address - Phone:412-586-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional