Provider Demographics
NPI:1154970234
Name:CLISTA, MATTHEW S
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:CLISTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 S BRADDOCK AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1889
Mailing Address - Country:US
Mailing Address - Phone:178-569-2837
Mailing Address - Fax:
Practice Address - Street 1:1789 S BRADDOCK AVE STE 360
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1889
Practice Address - Country:US
Practice Address - Phone:178-569-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013990101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health