Basic Information
| Provider Information | |||||||||
| NPI: | 1326597527 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INVERSO | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170465040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172725464 | ||||||||
| FaxNumber: | 7172731416 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 SCHOOL ST | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439527063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243961510 | ||||||||
| FaxNumber: | 7249724627 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2016 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW021022 | PA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | I.2002138 | OH | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | SW133257 | PA | N | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 0413076 | 05 | OH | MEDICAID |