Provider Demographics
NPI:1912061029
Name:DIMARCO, SUZANNE C (LCSW)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:C
Last Name:DIMARCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:C
Other - Last Name:HRAYCHUCK
Other - Suffix:SR
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:21 W FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-3429
Mailing Address - Country:US
Mailing Address - Phone:724-438-0336
Mailing Address - Fax:724-438-3466
Practice Address - Street 1:21 W FAYETTE ST
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-3429
Practice Address - Country:US
Practice Address - Phone:724-438-0336
Practice Address - Fax:724-438-3466
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0130691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
123197OtherVALUE OPTIONS
11584870OtherUNITED BEHAV HEALTH
PA646235OtherHIGHMARK
PA207235OtherUPMC
PA646235OtherHIGHMARK