Provider Demographics
NPI:1427844398
Name:MICALE, CARISSA (MS, NCC, LPC)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:MICALE
Suffix:
Gender:
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 DUTCHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15851-5913
Mailing Address - Country:US
Mailing Address - Phone:814-227-9920
Mailing Address - Fax:
Practice Address - Street 1:317 ELK RUN AVE
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-1621
Practice Address - Country:US
Practice Address - Phone:814-938-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC018494101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional