Provider Demographics
NPI:1417959354
Name:MOCK, JERRY (PHD)
Entity Type:Individual
Prefix:MRS
First Name:JERRY
Middle Name:
Last Name:MOCK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W POMFRET ST
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-3217
Mailing Address - Country:US
Mailing Address - Phone:717-258-0214
Mailing Address - Fax:717-258-3158
Practice Address - Street 1:47 W POMFRET ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-3217
Practice Address - Country:US
Practice Address - Phone:717-258-0214
Practice Address - Fax:717-258-3158
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008898L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122278OtherVALUE OPTIONS
PA810554001OtherAETNA PPO
PA0017562050002Medicaid
PA322506OtherMHNET
PA01756205OtherCOMMUNITY BEH. HEALTH
PA595346OtherHIGHMARK BLUE SHIELD
PA01082001OtherCAPITAL BLUE CROSS
PA810554001OtherAMERIHEALTH
PA810554001OtherQUEST
PA485274000OtherMAGELLAN
PA810554001OtherPACIFICARE
PA810554001OtherTEAM EAP
PA810554001OtherUNITED HEALTHCARE
PA810554001OtherPRIME SOURCE
PAMO595346OtherCIGNA
PA810554001OtherCOMPSYCH
PA7134268OtherAETNA
PA810554001OtherAETNA PPO
PA810554001OtherAMERIHEALTH