Provider Demographics
NPI:1104281989
Name:LAWRENCE M SATIFKA MA LLC
Entity type:Organization
Organization Name:LAWRENCE M SATIFKA MA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PA LICENSED PSYCHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SATIFKA
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:570-772-3090
Mailing Address - Street 1:200 PINE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6503
Mailing Address - Country:US
Mailing Address - Phone:570-772-3090
Mailing Address - Fax:570-300-2371
Practice Address - Street 1:200 PINE ST STE 400
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6503
Practice Address - Country:US
Practice Address - Phone:570-772-3090
Practice Address - Fax:570-300-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005192L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100743420005Medicaid