Provider Demographics
NPI:1508865114
Name:RESKO, BETH GABRIELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:GABRIELLE
Last Name:RESKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 ROLLING RIDGE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-7641
Mailing Address - Country:US
Mailing Address - Phone:814-867-0670
Mailing Address - Fax:814-867-7616
Practice Address - Street 1:320 ROLLING RIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-7641
Practice Address - Country:US
Practice Address - Phone:814-867-0670
Practice Address - Fax:814-867-7616
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0127201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S34921Medicare UPIN
692801Medicare ID - Type Unspecified