Provider Demographics
NPI:1316767866
Name:STOTSKY, DEREK ANDREW (LPC)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:ANDREW
Last Name:STOTSKY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-662-2650
Mailing Address - Fax:724-662-1338
Practice Address - Street 1:737 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:MERCER
Practice Address - State:PA
Practice Address - Zip Code:16137-5070
Practice Address - Country:US
Practice Address - Phone:724-662-2650
Practice Address - Fax:724-662-1338
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-10
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003622101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional