Healthcare Provider Details

I. General information

NPI: 1497672117
Provider Name (Legal Business Name): GAZOO DIAGNOSTIC ASSESSMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S STATE ST
CLARKS SUMMIT PA
18411-1684
US

IV. Provider business mailing address

421 S STATE ST
CLARKS SUMMIT PA
18411-1684
US

V. Phone/Fax

Practice location:
  • Phone: 570-983-4047
  • Fax:
Mailing address:
  • Phone: 570-983-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. COREY GAZOO
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 570-983-4047