Provider Demographics
NPI:1518204585
Name:NUNES, MARIO P (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:P
Last Name:NUNES
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 1:27241 ROUTE 267
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18818
Mailing Address - Country:US
Mailing Address - Phone:607-231-2422
Mailing Address - Fax:607-231-2422
Practice Address - Street 1:27241 STATE ROUTE 267
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18818-8640
Practice Address - Country:US
Practice Address - Phone:607-231-2422
Practice Address - Fax:607-231-2422
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0192271041C0700X
NY0836951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical