Healthcare Provider Details

I. General information

NPI: 1801989595
Provider Name (Legal Business Name): MARK R JONES ACSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5035 OLD WILLIAM PENN HWY
EXPORT PA
15632
US

IV. Provider business mailing address

4259 BULLTOWN RD
MURRYSVILLE PA
15668-9503
US

V. Phone/Fax

Practice location:
  • Phone: 724-733-3491
  • Fax: 724-733-3498
Mailing address:
  • Phone: 724-733-3801
  • Fax: 724-733-3498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW-001690-L
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier463873
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerVALUE OPTIONS PA ID#
# 2
Identifier9P587
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE BC/BS
# 3
Identifier000641940
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIMARK PA ID#

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: