Provider Demographics
NPI:1174533806
Name:REMICK, MARY CHRISTINE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:REMICK
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 35A
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:PA
Mailing Address - Zip Code:18414-9610
Mailing Address - Country:US
Mailing Address - Phone:570-563-2199
Mailing Address - Fax:570-563-2199
Practice Address - Street 1:421 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1684
Practice Address - Country:US
Practice Address - Phone:570-319-6965
Practice Address - Fax:570-319-6966
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006978L103TB0200X
PA#1-07-3652103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA#1-07-3652OtherBEHAVIOR ANALYTIC CERTIFICATION BOARD
PAPS006978LOtherPSYCHOLOGIST LICENSE