Provider Demographics
NPI:1588055784
Name:GILLISPIE, MARICA (LCSW)
Entity type:Individual
Prefix:
First Name:MARICA
Middle Name:
Last Name:GILLISPIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:KOSKO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-704-8886
Mailing Address - Fax:724-342-1942
Practice Address - Street 1:30 PINNACLE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-3800
Practice Address - Country:US
Practice Address - Phone:814-223-9914
Practice Address - Fax:814-223-9917
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0183841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical