Provider Demographics
NPI:1356501761
Name:VRESCAK, AMY J (LSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:VRESCAK
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 1:1070 OLD NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333
Mailing Address - Country:UM
Mailing Address - Phone:724-632-5828
Mailing Address - Fax:724-632-3198
Practice Address - Street 1:1070 OLD NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:PA
Practice Address - Zip Code:15333-2114
Practice Address - Country:US
Practice Address - Phone:724-632-5828
Practice Address - Fax:724-632-3198
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker