Provider Demographics
NPI:1689023251
Name:JESSICA B. MACRINO, LPC, LLC
Entity Type:Organization
Organization Name:JESSICA B. MACRINO, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:BORRERO
Authorized Official - Last Name:MACRINO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:814-882-8258
Mailing Address - Street 1:3641 STERRETTANIA RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-2826
Mailing Address - Country:US
Mailing Address - Phone:814-682-5053
Mailing Address - Fax:
Practice Address - Street 1:4508 ZUCK RD STE 1
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:814-682-5053
Practice Address - Fax:814-314-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007897101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032295520002Medicaid