Provider Demographics
NPI:1720115157
Name:HRISAK, CAMI A (MSSA, LCSW)
Entity Type:Individual
Prefix:
First Name:CAMI
Middle Name:A
Last Name:HRISAK
Suffix:
Gender:F
Credentials:MSSA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254-0063
Mailing Address - Country:US
Mailing Address - Phone:814-227-2232
Mailing Address - Fax:814-227-2401
Practice Address - Street 1:10956 ROUTE 322
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-4838
Practice Address - Country:US
Practice Address - Phone:814-227-2232
Practice Address - Fax:814-227-2401
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW018325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103037811Medicaid