Healthcare Provider Details

I. General information

NPI: 1831582311
Provider Name (Legal Business Name): MARGUERITE MOSACK, PHD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2015
Last Update Date: 03/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 SCHUYLER AVE SUITE 350
KINGSTON PA
18704-3336
US

IV. Provider business mailing address

239 SCHUYLER AVE SUITE 350
KINGSTON PA
18704-3336
US

V. Phone/Fax

Practice location:
  • Phone: 570-283-5580
  • Fax: 570-283-5583
Mailing address:
  • Phone: 570-283-5580
  • Fax: 570-283-5583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StatePA

VIII. Authorized Official

Name: DR. MARGUERITE MOSACK
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 570-283-5580