Provider Demographics
NPI:1972661031
Name:SOWCIK, MARK KAROL (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:KAROL
Last Name:SOWCIK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:119 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1035
Mailing Address - Country:US
Mailing Address - Phone:570-714-3860
Mailing Address - Fax:570-714-7594
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1210
Practice Address - Country:US
Practice Address - Phone:570-714-3860
Practice Address - Fax:570-714-7594
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004971-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015767170002Medicare ID - Type Unspecified19 PSYCHOLOGIST