Provider Demographics
NPI:1316026966
Name:DURICKO, ALLEN JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:JOHN
Last Name:DURICKO
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 1:300 MULBERRY ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1225
Mailing Address - Country:US
Mailing Address - Phone:570-969-2209
Mailing Address - Fax:570-969-2210
Practice Address - Street 1:300 MULBERRY ST
Practice Address - Street 2:SUITE 306
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1225
Practice Address - Country:US
Practice Address - Phone:570-969-2209
Practice Address - Fax:570-969-2210
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-002555-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA441666Medicare ID - Type Unspecified