Individual
MISS MARY LOUISE PETRISKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
6221 PHYSICIANS CT, SUITE 2, EVANSVILLE, IN 47715-4031
(812) 491-7739
(812) 491-8095
Mailing address
6221 PHYSICIANS CT, SUITE 2, EVANSVILLE, IN 47715-4031
(812) 491-7739
(812) 491-8095
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34003567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000301641
ANTHEM BCBS
IN
Enumeration date
09/08/2006
Last updated
02/08/2012
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