Provider Demographics
NPI:1144599747
Name:PETROSKI, CARLA R (LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:R
Last Name:PETROSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:RUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 HIGHLAND DR
Mailing Address - Street 2:P.O. BOX 597
Mailing Address - City:MOUNTVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17554-1232
Mailing Address - Country:US
Mailing Address - Phone:717-285-7121
Mailing Address - Fax:717-285-0616
Practice Address - Street 1:790 NEW HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2137
Practice Address - Country:US
Practice Address - Phone:717-390-0353
Practice Address - Fax:717-390-1812
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129184104100000X
PACW0195231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker