Healthcare Provider Details

I. General information

NPI: 1588055784
Provider Name (Legal Business Name): MARICA GILLISPIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCIA KOSKO LCSW

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PINNACLE DR SUITE 203
CLARION PA
16214-3800
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 814-223-9914
  • Fax: 814-223-9917
Mailing address:
  • Phone: 724-704-8886
  • Fax: 724-342-1942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018384
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: