MEDICARE: MRS. KATHLEEN M MARUSA LCSW

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	1041C0700X	Clinical Social Worker	CW015216	PA

General Provider Information

NPI Number	:	1265418685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN M MARUSA LCSW

Provider Business Mailing Address
First Line	:	223 PHILADELPHIA ST
Second Line	:
City	:	INDIANA
State	:	PA
Zip	:	15701-2053
Country	:	US
Telephone Number	:	724-541-1968
Fax Number	:

Provider Business Practice Location Address
First Line	:	647 PHILADELPHIA ST
Second Line	:	MIDTOWN BUILDING - SUITE 403
City	:	INDIANA
State	:	PA
Zip	:	15701-3923
Country	:	US
Telephone Number	:	724-541-1968
Fax Number	:

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

Provider Enumeration Date	:	12/17/2005
Last Update Date	:	02/27/2014

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