Provider Demographics
NPI:1013243252
Name:FIESTA, JAMES SULLIVAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SULLIVAN
Last Name:FIESTA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:610 E CRAWFORD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-2171
Mailing Address - Country:US
Mailing Address - Phone:724-603-2516
Mailing Address - Fax:724-603-2514
Practice Address - Street 1:610 E CRAWFORD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-2171
Practice Address - Country:US
Practice Address - Phone:724-603-2516
Practice Address - Fax:724-603-2514
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-22
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1264371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical