Healthcare Provider Details

I. General information

NPI: 1447340377
Provider Name (Legal Business Name): STEPHEN E MOCK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 01/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ADAMS AVE SUITE 305
SCRANTON PA
18510-2025
US

IV. Provider business mailing address

PO BOX 406153 SUITE 305
ATLANTA GA
30384-6153
US

V. Phone/Fax

Practice location:
  • Phone: 570-344-4327
  • Fax: 570-344-7822
Mailing address:
  • Phone: 570-344-4327
  • Fax: 570-344-7822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberAT000199L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAT000199L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000199L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code231HA2400X
TaxonomyAssistive Technology Practitioner Audiologist
License NumberAT000199L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code231HA2500X
TaxonomyAssistive Technology Supplier Audiologist
License NumberAT000199L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAT000199L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: