Provider Demographics
NPI:1316262306
Name:GEORGE E. DALZELL, LCSW
Entity type:Organization
Organization Name:GEORGE E. DALZELL, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.C.S.W.
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DALZELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-904-1480
Mailing Address - Street 1:1201 S BRADDOCK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1275
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 S BRADDOCK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1275
Practice Address - Country:US
Practice Address - Phone:412-904-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW015639251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health