Provider Demographics
NPI:1467293514
Name:FRISINO, AMY GAIL (LPC)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:GAIL
Last Name:FRISINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLARKS GREEN
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2500
Mailing Address - Country:US
Mailing Address - Phone:570-209-0544
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 36
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:PA
Practice Address - Zip Code:18471-0036
Practice Address - Country:US
Practice Address - Phone:570-563-8445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016755101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional