Healthcare Provider Details

I. General information

NPI: 1801467840
Provider Name (Legal Business Name): JOHN MERCHANT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JACK MERCHANT

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 LARCH ST
SCRANTON PA
18509-2802
US

IV. Provider business mailing address

317 LINDEN ST APT 107
SCRANTON PA
18503-1506
US

V. Phone/Fax

Practice location:
  • Phone: 570-489-5561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: