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Individual

GINA PROVISIERO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
777 BLAKESLEE BLVD DR E, SUITE 3, LEHIGHTON, PA 18235
(631) 512-1264
Mailing address
32 W WALTER ST, FL 1, SUMMIT HILL, PA 18250-1412
(631) 512-1264

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
SW133460
PA
1041C0700X
Clinical Social Worker
Primary

Other

Enumeration date
09/11/2016
Last updated
08/29/2019
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