Provider Demographics
NPI:1235280074
Name:ROSKO KUBISTEK, PATRICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:ROSKO KUBISTEK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:ROSKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PATRICIA ROSKO KUBISTEK
Mailing Address - Street 2:1407 MAIN ST.
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2256
Mailing Address - Country:US
Mailing Address - Phone:724-537-1974
Mailing Address - Fax:724-537-1918
Practice Address - Street 1:PATRICIA ROSKO KUBISTEK
Practice Address - Street 2:121 WEST 2ND AVE
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-2256
Practice Address - Country:US
Practice Address - Phone:724-539-3040
Practice Address - Fax:724-537-1918
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW003900-L101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025571290002Medicaid