Provider Demographics
NPI:1043487861
Name:YUSHCHAK, MARK A (PSYD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:YUSHCHAK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2312
Mailing Address - Country:US
Mailing Address - Phone:908-725-8880
Mailing Address - Fax:908-725-5656
Practice Address - Street 1:62 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2312
Practice Address - Country:US
Practice Address - Phone:908-725-8880
Practice Address - Fax:908-725-5656
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100441800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist