Provider Demographics
NPI:1265480859
Name:VERRETT, MARIANNE (LSW)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:VERRETT
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0189
Mailing Address - Country:US
Mailing Address - Phone:724-728-7060
Mailing Address - Fax:724-728-9962
Practice Address - Street 1:1417 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2427
Practice Address - Country:US
Practice Address - Phone:724-728-7060
Practice Address - Fax:724-728-9962
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW0080571104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA217981-A123424OtherVALUE OPTIONS
PA923444OtherKEYSTONE HEALTH PLAN WEST