Healthcare Provider Details

I. General information

NPI: 1457466443
Provider Name (Legal Business Name): MARY JANE GRISNIK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 W PITTSBURGH ST
GREENSBURG PA
15601-2239
US

IV. Provider business mailing address

523 WEST PITTSBURGH STREET
GREENSBURG PA
15601
US

V. Phone/Fax

Practice location:
  • Phone: 412-817-9340
  • Fax: 724-832-5174
Mailing address:
  • Phone: 412-817-9340
  • Fax: 724-832-5174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013382
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: