Basic Information
| Provider Information | |||||||||
| NPI: | 1609400142 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AULISIO | ||||||||
| FirstName: | CHERI | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | TAYLOR | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185171107 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 501 S WASHINGTON AVE STE 1000 | ||||||||
| Address2: | |||||||||
| City: | SCRANTON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 185053814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709410630 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/24/2020 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW123865 | PA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.