MEDICARE: DR. MARILYN LIVOSKY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PS-008489L	PA

General Provider Information

NPI Number	:	1124149935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN LIVOSKY PH.D.

Provider Business Mailing Address
First Line	:	866 W ARLINGTON RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16509-2150
Country	:	US
Telephone Number	:	814-866-3006
Fax Number	:

Provider Business Practice Location Address
First Line	:	4402 PEACH ST
Second Line	:	NORTH WING
City	:	ERIE
State	:	PA
Zip	:	16509-1358
Country	:	US
Telephone Number	:	814-860-8444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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