Provider Demographics
NPI:1760865315
Name:PUSATERI, MARINA (LSW)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:PUSATERI
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LOCK HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17745-2812
Mailing Address - Country:US
Mailing Address - Phone:570-748-7173
Mailing Address - Fax:570-748-5717
Practice Address - Street 1:120 S HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:LOCK HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17745-2812
Practice Address - Country:US
Practice Address - Phone:570-748-7173
Practice Address - Fax:570-748-5717
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW122530101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health