Provider Demographics
NPI:1457597429
Name:MICCO, ERIN R (MSW LSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:R
Last Name:MICCO
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:R
Other - Last Name:WIESECKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:318 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-3626
Mailing Address - Country:US
Mailing Address - Phone:724-654-9555
Mailing Address - Fax:724-654-6766
Practice Address - Street 1:318 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-3626
Practice Address - Country:US
Practice Address - Phone:724-654-9555
Practice Address - Fax:724-654-6766
Is Sole Proprietor?:No
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126418104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker