Provider Demographics
NPI:1528823101
Name:MARISCOTTI, JANINE (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:MARISCOTTI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 EDGLEY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-5304
Mailing Address - Country:US
Mailing Address - Phone:215-813-7067
Mailing Address - Fax:
Practice Address - Street 1:314 EDGLEY AVE
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-5304
Practice Address - Country:US
Practice Address - Phone:215-813-7067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW003524L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical