MEDICARE: KIMBERLY PISARCIK, LCSW THERAPY, LLC

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

General Provider Information

NPI Number	:	1255881405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY PISARCIK, LCSW THERAPY, LLC

Provider Business Mailing Address
First Line	:	1 TARLETON AVE
Second Line	:	SUITE 3
City	:	DALLAS
State	:	PA
Zip	:	18612-1248
Country	:	US
Telephone Number	:	570-310-1214
Fax Number	:	570-310-1214

Provider Business Practice Location Address
First Line	:	1 TARLETON AVE
Second Line	:	SUITE 3
City	:	DALLAS
State	:	PA
Zip	:	18612-1248
Country	:	US
Telephone Number	:	570-310-1214
Fax Number	:	570-310-1214

Authorized Official
Title or Position	:	THERAPIST
Name	:	KIMBERLY PISARCIK
Credential	:	LCSW
Telephone Number	:	570-310-1214

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	10/12/2016

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