Provider Demographics
NPI:1124069810
Name:BASINGER, MARK ALAN (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BASINGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 BILL SONES RD
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-7269
Mailing Address - Country:US
Mailing Address - Phone:570-524-9477
Mailing Address - Fax:570-524-9492
Practice Address - Street 1:1800 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-1236
Practice Address - Country:US
Practice Address - Phone:570-524-9477
Practice Address - Fax:570-524-9492
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0144441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080466OtherFPH - WMSPT ONLY
PA50000162OtherCAPITAL BLUE CROSS
PA697394KLTMedicare ID - Type UnspecifiedMCR - LEWISBURG OFFICE