Provider Demographics
NPI:1396234621
Name:OTT, BERNARD (LSW)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:OTT
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 ROUSER RD
Mailing Address - Street 2:
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-6801
Mailing Address - Country:US
Mailing Address - Phone:412-604-8900
Mailing Address - Fax:412-299-8755
Practice Address - Street 1:470 STREETS RUN RD STE 202
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-2023
Practice Address - Country:US
Practice Address - Phone:412-466-7734
Practice Address - Fax:412-884-1374
Is Sole Proprietor?:No
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009423L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker