MEDICARE: MS. LISA M. MARSICANO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW013814	PA

General Provider Information

NPI Number	:	1073814885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA M. MARSICANO LCSW

Provider Business Mailing Address
First Line	:	1216 HOWARD AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-3315
Country	:	US
Telephone Number	:	570-622-1454
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 W END AVE
Second Line	:
City	:	POTTSVILLE
State	:	PA
Zip	:	17901-2050
Country	:	US
Telephone Number	:	570-622-9101
Fax Number	:	570-622-9102

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	09/29/2014

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