Provider Demographics
NPI:1588909691
Name:MARSICO, KIMBERLY SUE (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SUE
Last Name:MARSICO
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4157 BOSLEY SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:17327-7713
Mailing Address - Country:US
Mailing Address - Phone:717-968-1296
Mailing Address - Fax:814-734-0196
Practice Address - Street 1:4157 BOSLEY SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:PA
Practice Address - Zip Code:17327-7713
Practice Address - Country:US
Practice Address - Phone:717-968-1296
Practice Address - Fax:814-734-0196
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional