Healthcare Provider Details

I. General information

NPI: 1912061029
Provider Name (Legal Business Name): SUZANNE C DIMARCO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SUZANNE C HRAYCHUCK SR. LCSW

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W FAYETTE ST
UNIONTOWN PA
15401-3429
US

IV. Provider business mailing address

21 W FAYETTE ST
UNIONTOWN PA
15401-3429
US

V. Phone/Fax

Practice location:
  • Phone: 724-438-0336
  • Fax: 724-438-3466
Mailing address:
  • Phone: 724-438-0336
  • Fax: 724-438-3466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW013069
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier123197
Identifier TypeOTHER
Identifier State
Identifier IssuerVALUE OPTIONS
# 2
Identifier11584870
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED BEHAV HEALTH
# 3
Identifier646235
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK
# 4
Identifier207235
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: