Healthcare Provider Details

I. General information

NPI: 1184190233
Provider Name (Legal Business Name): LUCHANSKY PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 BEDFORD ST STE C
CLARKS SUMMIT PA
18411-1801
US

IV. Provider business mailing address

395 BEDFORD ST STE C
CLARKS SUMMIT PA
18411-1801
US

V. Phone/Fax

Practice location:
  • Phone: 570-954-6961
  • Fax: 570-319-9674
Mailing address:
  • Phone: 570-954-6961
  • Fax: 570-319-9674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: AMANDA LUCHANSKY
Title or Position: LICENSED PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 570-954-6961