Provider Demographics
NPI:1588717946
Name:NORCROSS, JOHN C (PHD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:NORCROSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-8888
Mailing Address - Country:US
Mailing Address - Phone:570-585-5726
Mailing Address - Fax:
Practice Address - Street 1:401 ADAMS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-2025
Practice Address - Country:US
Practice Address - Phone:570-969-2209
Practice Address - Fax:570-969-2210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004708L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA199848Medicare ID - Type Unspecified