Provider Demographics
NPI:1528532744
Name:WILSON, MARLANA JOY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARLANA
Middle Name:JOY
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARLANA
Other - Middle Name:JOY
Other - Last Name:REGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-1259
Mailing Address - Country:US
Mailing Address - Phone:412-403-7148
Mailing Address - Fax:
Practice Address - Street 1:1031 THREE DEGREE RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16002-0465
Practice Address - Country:US
Practice Address - Phone:412-403-7148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135038104100000X
PACW0214671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker