Gina Provisiero, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Practice address

777 Blakeslee Blvd Dr E
Suite 3
Lehighton, PA 18235

Phone

(631) 512-1264

NPI assigned

Sep 11, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1093262727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "32 W WALTER ST",
            "address_2": "FL 1",
            "city": "SUMMIT HILL",
            "state": "PA",
            "postal_code": "182501412",
            "telephone_number": "631-512-1264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 BLAKESLEE BLVD DR E",
            "address_2": "SUITE 3",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "18235",
            "telephone_number": "631-512-1264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "430 W White St Apt 2",
            "address_purpose": "LOCATION",
            "city": "Summit Hill",
            "state": "PA",
            "postal_code": "182501028",
            "country_code": "US",
            "telephone_number": "631-512-1264",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PROVISIERO",
        "first_name": "GINA",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-11",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW133460",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phoenix Rehabilitation and Health Services, Inc.
• Samantha Postupack, M.A. CCC-SLP
• Luke John Price, PA-C
• Eric Michael Pridgen, MD
• Professional Care Partnership, LLC (Senior Helpers)
• Pulmonary Specialists, LLC
• Emily Quigley
• Alyssa Quiteles, PT, DPT
• Rafael Cruz MD Family Practice Limited Liability Company
• Pranjali Shreyas Ranadive, DMD

• Clinical Social Worker in Lehighton, PA
• Providers in Lehighton, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.