Provider Demographics
NPI:1669507125
Name:SARBAK, JOSEPH A (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:SARBAK
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 1:4508 ZUCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-4523
Mailing Address - Country:US
Mailing Address - Phone:814-833-4853
Mailing Address - Fax:814-833-0438
Practice Address - Street 1:4508 ZUCK RD STE 2
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4523
Practice Address - Country:US
Practice Address - Phone:814-833-4853
Practice Address - Fax:814-833-0438
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013599L104100000X
PACW0160621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026257930005Medicaid
PA462600902OtherTAX ID