Provider Demographics
NPI:1609924711
Name:MUKLEWICZ, CHET (EDD)
Entity Type:Individual
Prefix:DR
First Name:CHET
Middle Name:
Last Name:MUKLEWICZ
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1527 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18509-2437
Mailing Address - Country:US
Mailing Address - Phone:570-344-1669
Mailing Address - Fax:570-344-8684
Practice Address - Street 1:1030 MARION ST
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-2316
Practice Address - Country:US
Practice Address - Phone:570-961-0600
Practice Address - Fax:570-961-0600
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA008482-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist