Provider Demographics
NPI:1659525897
Name:MARCHESANI, SUSIE ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSIE
Middle Name:ELIZABETH
Last Name:MARCHESANI
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:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:SMETHPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16749-0752
Mailing Address - Country:US
Mailing Address - Phone:814-887-7754
Mailing Address - Fax:814-887-2360
Practice Address - Street 1:203 W MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:SMETHPORT
Practice Address - State:PA
Practice Address - Zip Code:16749-1259
Practice Address - Country:US
Practice Address - Phone:814-887-7754
Practice Address - Fax:814-887-2360
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0169141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical