1417959354 NPI number — MRS. JERRY MOCK PH.D.

Table of content: MRS. JERRY MOCK PH.D. (NPI 1417959354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417959354 NPI number — MRS. JERRY MOCK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOCK
Provider First Name:
JERRY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417959354
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 W POMFRET ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLISLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17013-3217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-258-0214
Provider Business Mailing Address Fax Number:
717-258-3158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 W POMFRET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17013-3217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-258-0214
Provider Business Practice Location Address Fax Number:
717-258-3158
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  008898L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 122278 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017562050002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 322506 . This is a "MHNET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01756205 . This is a "COMMUNITY BEH. HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 595346 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01082001 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "QUEST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 485274000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "PACIFICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "TEAM EAP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "PRIME SOURCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: MO595346 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 810554001 . This is a "COMPSYCH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7134268 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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