Provider Demographics
NPI:1265552509
Name:MERTZ, MARYJANE LESNICK (LCSW ACSW DCSW)
Entity type:Individual
Prefix:MRS
First Name:MARYJANE
Middle Name:LESNICK
Last Name:MERTZ
Suffix:
Gender:F
Credentials:LCSW ACSW DCSW
Other - Prefix:
Other - First Name:MARYJANE
Other - Middle Name:LESNICK
Other - Last Name:MERTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW ACSW DCSW
Mailing Address - Street 1:9290 BARNES LAKE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3171
Mailing Address - Country:US
Mailing Address - Phone:412-303-7602
Mailing Address - Fax:724-515-5146
Practice Address - Street 1:9290 BARNES LAKE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-3171
Practice Address - Country:US
Practice Address - Phone:412-303-7602
Practice Address - Fax:724-515-5146
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001836L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IP134265Medicare UPIN
R08084Medicare UPIN
PA645403Medicare ID - Type Unspecified