Provider Demographics
NPI:1265418685
Name:MARUSA, KATHLEEN M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:M
Last Name:MARUSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:STANCOMBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:223 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-2053
Mailing Address - Country:US
Mailing Address - Phone:724-541-1968
Mailing Address - Fax:
Practice Address - Street 1:647 PHILADELPHIA ST
Practice Address - Street 2:MIDTOWN BUILDING - SUITE 403
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3923
Practice Address - Country:US
Practice Address - Phone:724-541-1968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103857Medicare PIN