Provider Demographics
NPI:1376691816
Name:SCISSOM, MARGARET J (LSW)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:J
Last Name:SCISSOM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:J
Other - Last Name:VIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7125 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46403-2040
Mailing Address - Country:US
Mailing Address - Phone:219-939-0821
Mailing Address - Fax:219-757-1950
Practice Address - Street 1:3903 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2555
Practice Address - Country:US
Practice Address - Phone:219-962-5311
Practice Address - Fax:219-757-1950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33002398A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical