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1417959354

NPI Code Detail

MEDICARE: MRS. JERRY MOCK PH.D.

MEDICARE: MRS. JERRY MOCK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	008898L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122278	OTHER	PA	VALUE OPTIONS
2	810554001	OTHER	PA	AETNA PPO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	322506	OTHER	PA	MHNET
5	01756205	OTHER	PA	COMMUNITY BEH. HEALTH
6	595346	OTHER	PA	HIGHMARK BLUE SHIELD
7	01082001	OTHER	PA	CAPITAL BLUE CROSS
8	810554001	OTHER	PA	AMERIHEALTH
9	810554001	OTHER	PA	QUEST
10	485274000	OTHER	PA	MAGELLAN
11	810554001	OTHER	PA	PACIFICARE
12	810554001	OTHER	PA	TEAM EAP
13	810554001	OTHER	PA	UNITED HEALTHCARE
14	810554001	OTHER	PA	PRIME SOURCE
15	MO595346	OTHER	PA	CIGNA
16	810554001	OTHER	PA	COMPSYCH
17	7134268	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1417959354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JERRY MOCK PH.D.

Provider Business Mailing Address
First Line	:	47 W POMFRET ST
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3217
Country	:	US
Telephone Number	:	717-258-0214
Fax Number	:	717-258-3158

Provider Business Practice Location Address
First Line	:	47 W POMFRET ST
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3217
Country	:	US
Telephone Number	:	717-258-0214
Fax Number	:	717-258-3158

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	03/12/2010

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Directions to “ MRS. JERRY MOCK PH.D.” Practice Location

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