Individual
MR. MICHAEL G MERVOSH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED.
Contact information
Practice address
5655 BRYANT ST, PITTSBURGH, PA 15206
(412) 363-1530
Mailing address
5655 BRYANT ST, PITTSBURGH, PA 15206
(412) 363-1530
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS007863L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
706025
PA BLUE SHIELD
PA
Enumeration date
05/01/2007
Last updated
07/08/2007
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