Provider Demographics
NPI:1790887032
Name:DIMARCO, ANN MARIE (LICSW ACSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARIE
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:LICSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-6969
Mailing Address - Country:US
Mailing Address - Phone:304-290-9732
Mailing Address - Fax:
Practice Address - Street 1:91 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26501-6969
Practice Address - Country:US
Practice Address - Phone:304-290-9732
Practice Address - Fax:304-291-2918
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
WVOP009390591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV264256000OtherMAGELLAN
WV001712447OtherBCBS
WVY546125OtherMAGELLAN