Healthcare Provider Details

I. General information

NPI: 1881485381
Provider Name (Legal Business Name): CARLY MARIE FUSILLI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22868 ROUTE 68
CLARION PA
16214-8566
US

IV. Provider business mailing address

22868 ROUTE 68
CLARION PA
16214-8566
US

V. Phone/Fax

Practice location:
  • Phone: 814-227-2941
  • Fax: 800-886-4087
Mailing address:
  • Phone: 814-227-2941
  • Fax: 800-886-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC018523
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: