Provider Demographics
NPI:1831999671
Name:SUKENIK-DEMARK, LAURIE LOURDES
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LOURDES
Last Name:SUKENIK-DEMARK
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:LOURDES
Other - Last Name:SUKENIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2157 ELKDALE RD
Mailing Address - Street 2:
Mailing Address - City:CLIFFORD TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18470-7852
Mailing Address - Country:US
Mailing Address - Phone:570-960-1743
Mailing Address - Fax:
Practice Address - Street 1:2157 ELKDALE RD
Practice Address - Street 2:
Practice Address - City:CLIFFORD TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18470-7852
Practice Address - Country:US
Practice Address - Phone:570-960-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty