Provider Demographics
NPI:1851702799
Name:MAROUCHOC, DAVID (LSW)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MAROUCHOC
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:JIM THORPE
Mailing Address - State:PA
Mailing Address - Zip Code:18229-2207
Mailing Address - Country:US
Mailing Address - Phone:570-249-0228
Mailing Address - Fax:
Practice Address - Street 1:701 BRIDGE ST
Practice Address - Street 2:STE 206
Practice Address - City:LEHIGHTON
Practice Address - State:PA
Practice Address - Zip Code:18235-1800
Practice Address - Country:US
Practice Address - Phone:570-249-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0202861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty