Provider Demographics
NPI:1477985752
Name:MARK SOWCIK, PSYCHOLOGIST, LLC
Entity Type:Organization
Organization Name:MARK SOWCIK, PSYCHOLOGIST, LLC
Other - Org Name:EVERGREEN BEHAVIORAL INTERVENTION FOR CHILDREN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOWCIK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:570-793-1981
Mailing Address - Street 1:90 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1210
Mailing Address - Country:US
Mailing Address - Phone:570-793-1981
Mailing Address - Fax:
Practice Address - Street 1:90 MAIN ST
Practice Address - Street 2:
Practice Address - City:LUZERNE
Practice Address - State:PA
Practice Address - Zip Code:18709-1210
Practice Address - Country:US
Practice Address - Phone:570-793-1981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004971L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty