Provider Demographics
NPI:1790964898
Name:FINCH, EDWIN CLARKE (PHD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:CLARKE
Last Name:FINCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 PINE ST
Mailing Address - Street 2:SUITE 2 S
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-6200
Mailing Address - Country:US
Mailing Address - Phone:570-327-1414
Mailing Address - Fax:570-327-1616
Practice Address - Street 1:454 PINE ST
Practice Address - Street 2:SUITE 2 S
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-6200
Practice Address - Country:US
Practice Address - Phone:570-327-1414
Practice Address - Fax:570-327-1616
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005718-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014074740011Medicaid