Provider Demographics
NPI:1134217599
Name:CAMUSO, ROBERTA A (MA NCC LPC)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:A
Last Name:CAMUSO
Suffix:
Gender:F
Credentials:MA NCC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 BLUE JAY DR
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-8715
Mailing Address - Country:US
Mailing Address - Phone:814-375-2393
Mailing Address - Fax:
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1894
Practice Address - Country:US
Practice Address - Phone:814-591-9038
Practice Address - Fax:814-375-5582
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health