Provider Demographics
NPI:1801989595
Name:JONES, MARK R (ACSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:JONES
Suffix:
Gender:M
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4259 BULLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9503
Mailing Address - Country:US
Mailing Address - Phone:724-733-3801
Mailing Address - Fax:724-733-3498
Practice Address - Street 1:5035 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:EXPORT
Practice Address - State:PA
Practice Address - Zip Code:15632
Practice Address - Country:US
Practice Address - Phone:724-733-3491
Practice Address - Fax:724-733-3498
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-001690-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA463873OtherVALUE OPTIONS PA ID#
NY9P587OtherEMPIRE BC/BS
PA000641940OtherHIMARK PA ID#
PA641940Medicare ID - Type UnspecifiedMEDICARE ID #