Provider Demographics
NPI:1811099989
Name:GERSON, MARCIE JOE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:JOE
Last Name:GERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 S CRAIG ST
Mailing Address - Street 2:STE 2D
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213
Mailing Address - Country:US
Mailing Address - Phone:412-681-2188
Mailing Address - Fax:412-681-2280
Practice Address - Street 1:311 S CRAIG ST
Practice Address - Street 2:STE 2D
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213
Practice Address - Country:US
Practice Address - Phone:412-681-2188
Practice Address - Fax:412-681-2280
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005501L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
S13825Medicare UPIN