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General NPI Number Information
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NPI Number | 1477985752
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Entity Type | Organization
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Legal Business Name | MARK SOWCIK, PSYCHOLOGIST, LLC
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 08/08/2013
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Provider Practice Location Address
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Address Line | 90 MAIN ST
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City | LUZERNE
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State | PA
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Zip | 18709-1210
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Country | US
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Telephone | 570-793-1981
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Fax |
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Provider Business Mailing Address
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Address Line | 90 MAIN ST
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City | LUZERNE
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State | PA
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Zip | 18709-1210
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Country | US
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Telephone | 570-793-1981
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. MARK K SOWCIK
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Credential | PH.D.
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Telephone | 570-793-1981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS-004971L
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License Number State | PA
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