Provider Demographics
NPI:1336168962
Name:GOBERISH, DONNA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:MARIE
Last Name:GOBERISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 FREEPORT RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3131
Mailing Address - Country:US
Mailing Address - Phone:412-967-5660
Mailing Address - Fax:
Practice Address - Street 1:1326 FREEPORT RD
Practice Address - Street 2:SUITE 250
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3131
Practice Address - Country:US
Practice Address - Phone:412-967-5660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0124591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA757802Medicare ID - Type Unspecified