Provider Demographics
NPI:1760450282
Name:PINSKER, MARK ARTHUR (EDD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ARTHUR
Last Name:PINSKER
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 1:1241 MALL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4879
Mailing Address - Country:US
Mailing Address - Phone:804-380-9488
Mailing Address - Fax:804-794-9868
Practice Address - Street 1:1241 MALL DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4879
Practice Address - Country:US
Practice Address - Phone:804-380-9488
Practice Address - Fax:804-794-9868
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001720103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA07751257Medicaid
VA07751257Medicaid
VAR63027Medicare UPIN