Basic Information
| Provider Information | |||||||||
| NPI: | 1588055784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILLISPIE | ||||||||
| FirstName: | MARICA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KOSKO | ||||||||
| OtherFirstName: | MARCIA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 100 SHENANGO AVE | ||||||||
| Address2: | |||||||||
| City: | SHARON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 161461503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247048886 | ||||||||
| FaxNumber: | 7243421942 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 PINNACLE DR | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CLARION | ||||||||
| State: | PA | ||||||||
| PostalCode: | 162143800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8142239914 | ||||||||
| FaxNumber: | 8142239917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2015 | ||||||||
| LastUpdateDate: | 03/09/2015 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW018384 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.