Healthcare Provider Details

I. General information

NPI: 1023560950
Provider Name (Legal Business Name): NICOLE MARINACCI-MAGEE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARINACCI LSW

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COMMERCE DR SUITE 1008
MOON TOWNSHIP PA
15108-4739
US

IV. Provider business mailing address

1233 SWEARINGEN RD
WEIRTON WV
26062-4330
US

V. Phone/Fax

Practice location:
  • Phone: 412-299-8404
  • Fax:
Mailing address:
  • Phone: 412-973-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017993
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: