Provider Demographics
NPI:1073814885
Name:MARSICANO, LISA M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:MARSICANO
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 1:1216 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3315
Mailing Address - Country:US
Mailing Address - Phone:570-622-1454
Mailing Address - Fax:
Practice Address - Street 1:1851 W END AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2050
Practice Address - Country:US
Practice Address - Phone:570-622-9101
Practice Address - Fax:570-622-9102
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0138141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical