Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC012109 | PA |
NPI | 1003446238 |
---|---|
Provider Name | Matthew Kevin Sitosky |
First Address | Rural Valley, PA 16249-1813 |
Second Address | Clarion, PA 16214-1543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2020 |
Last Update Date | 15/01/2020 |