Provider Demographics
NPI:1033261540
Name:PEARSALL, MARCY L (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARCY
Middle Name:L
Last Name:PEARSALL
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1502
Mailing Address - Country:US
Mailing Address - Phone:724-651-6596
Mailing Address - Fax:
Practice Address - Street 1:311 5TH ST
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1903
Practice Address - Country:US
Practice Address - Phone:724-752-0116
Practice Address - Fax:724-752-1113
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0131531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA629017OtherHIGHMARK BCBS
PA034504Medicare ID - Type Unspecified
PA596243Medicare UPIN