Maryanne Wally, LPC
Individual provider Active NPI Professional Counselor · Etna, PA
NPI 1154042596 · NPPES record last updated Sep 5, 2022
Key facts
- NPI
- 1154042596
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- PC014602 (PA)
- Practice address
- 43 Grant Ave
Etna, PA 15223-1841 - Phone
- (412) 480-6854
- NPI assigned
- Sep 5, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC014602 | PA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wesley Family Services | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC014602 | PA | Yes |
Addresses
Primary practice location
43 Grant Ave
Etna, PA 15223-1841
Mailing address
43 Grant Ave
Etna, PA 15223-1841
Phone (412) 480-6854
Other providers in Etna, PA
- Lakshmi Kalyani Kodey
- Suzanne Meredith Labriola
- Labriolas Integrative Health PC
- Manor Care Nursing and Rehabilitaion Center
- Kathleen Skubak
All providers in Etna, PA · Professional Counselor in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.