Provider Demographics
NPI:1184717134
Name:WARNITSKY, MARIETTA (MSW LCSW QCSW)
Entity type:Individual
Prefix:MS
First Name:MARIETTA
Middle Name:
Last Name:WARNITSKY
Suffix:
Gender:F
Credentials:MSW LCSW QCSW
Other - Prefix:MS
Other - First Name:MARIETTA
Other - Middle Name:
Other - Last Name:SCALISE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW LCSW
Mailing Address - Street 1:340 MONTAGE MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1782
Mailing Address - Country:US
Mailing Address - Phone:570-346-3686
Mailing Address - Fax:570-558-6838
Practice Address - Street 1:340 MONTAGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1782
Practice Address - Country:US
Practice Address - Phone:570-346-3686
Practice Address - Fax:570-558-6838
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW006795L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA677780Q92Medicare ID - Type Unspecified