Provider Demographics
NPI:1477720761
Name:PRYOR, EUGENE PATRICK JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:PATRICK
Last Name:PRYOR
Suffix:JR
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 1:120 NORTH ABINGTON ROAD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2541
Mailing Address - Country:US
Mailing Address - Phone:570-586-2966
Mailing Address - Fax:
Practice Address - Street 1:120 NORTH ABINGTON ROAD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2541
Practice Address - Country:US
Practice Address - Phone:570-586-2966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY134102L00000X
PAPS004383L103T00000X, 103TC0700X
MA3382103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPR152198OtherBCBS
MAPRW03427OtherBCBS