Healthcare Provider Details

I. General information

NPI: 1336132752
Provider Name (Legal Business Name): MARTIN R MCGURRIN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N. ABINGTON ROAD
CLARKS SUMMIT PA
18411
US

IV. Provider business mailing address

120 N. ABINGTON ROAD
CLARKS SUMMIT PA
18411
US

V. Phone/Fax

Practice location:
  • Phone: 570-586-4343
  • Fax:
Mailing address:
  • Phone: 570-586-4343
  • Fax: 570-586-2196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW014247
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: