Provider Demographics
NPI:1386744985
Name:SUNICK, MARY BETH C (PHD)
Entity type:Individual
Prefix:
First Name:MARY BETH
Middle Name:C
Last Name:SUNICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LITTLE SPIKE WAY
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-1282
Mailing Address - Country:US
Mailing Address - Phone:570-576-5086
Mailing Address - Fax:570-587-4521
Practice Address - Street 1:210 N STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1008
Practice Address - Country:US
Practice Address - Phone:570-587-5086
Practice Address - Fax:570-587-4521
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-0088098L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist