Healthcare Provider Details

I. General information

NPI: 1619252962
Provider Name (Legal Business Name): MARISSA MATEER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISSA KAMINISK LCSW

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 06/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 VIRGINIA AVE
ROCHESTER PA
15074-1723
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-770-9095
  • Fax: 724-770-9096
Mailing address:
  • Phone: 724-770-9095
  • Fax: 724-770-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW129029
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW018005
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: