Provider Demographics
NPI:1124149935
Name:LIVOSKY, MARILYN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:LIVOSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:866 W ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509-2150
Mailing Address - Country:US
Mailing Address - Phone:814-866-3006
Mailing Address - Fax:
Practice Address - Street 1:4402 PEACH ST
Practice Address - Street 2:NORTH WING
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-1358
Practice Address - Country:US
Practice Address - Phone:814-860-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-008489L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist