Provider Demographics
NPI:1235680562
Name:ZACIOS, GINA (LSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:ZACIOS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 HOOKSTOWN GRADE RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:PA
Mailing Address - Zip Code:15026-1814
Mailing Address - Country:US
Mailing Address - Phone:412-303-3723
Mailing Address - Fax:412-894-8606
Practice Address - Street 1:2402 HOOKSTOWN GRADE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:PA
Practice Address - Zip Code:15026-1814
Practice Address - Country:US
Practice Address - Phone:412-303-3723
Practice Address - Fax:412-894-8606
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1253541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical