Provider Demographics
NPI:1215911482
Name:CZERPAK, GLORIA (LSW)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:CZERPAK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S MARKET ST
Mailing Address - Street 2:LIGONIER VALLEY LEARNING CENTER INC
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1214
Mailing Address - Country:US
Mailing Address - Phone:724-238-0355
Mailing Address - Fax:724-238-0352
Practice Address - Street 1:117 JUNIPER LN
Practice Address - Street 2:LIGONIER VALLEY LEARNING CENTER INC
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-9727
Practice Address - Country:US
Practice Address - Phone:724-238-5556
Practice Address - Fax:724-238-9533
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW009555L104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1001348580007Medicaid