Provider Demographics
NPI:1336132752
Name:MCGURRIN, MARTIN R (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:MCGURRIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N. ABINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411
Mailing Address - Country:US
Mailing Address - Phone:570-586-4343
Mailing Address - Fax:570-586-2196
Practice Address - Street 1:120 N. ABINGTON ROAD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411
Practice Address - Country:US
Practice Address - Phone:570-586-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0142471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical