Provider Demographics
NPI:1437574878
Name:MARUCCO, ANTHONY MARK (LCSW)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:MARK
Last Name:MARUCCO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 DANTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-8856
Mailing Address - Country:US
Mailing Address - Phone:717-342-7958
Mailing Address - Fax:
Practice Address - Street 1:13 DANTE BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-8856
Practice Address - Country:US
Practice Address - Phone:717-342-7958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical