Provider Demographics
NPI:1275743999
Name:GANS, MARK DAVID (MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:GANS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18067-8709
Mailing Address - Country:US
Mailing Address - Phone:610-432-4189
Mailing Address - Fax:
Practice Address - Street 1:402 N FULTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-2002
Practice Address - Country:US
Practice Address - Phone:610-432-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health