Provider Demographics
NPI:1043256365
Name:OSUCH, CHERYL A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:A
Last Name:OSUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 N MOUNTAIN RD STE 308
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1795
Mailing Address - Country:US
Mailing Address - Phone:717-219-4147
Mailing Address - Fax:
Practice Address - Street 1:1250 N MOUNTAIN RD STE 308
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1795
Practice Address - Country:US
Practice Address - Phone:717-219-4147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0771421041C0700X
PACW0191471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07200068680Medicaid