Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS005634L | PA |
Y | 103T00000X | Psychologist | PS005634L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS005634L | PA |
NPI | 1447606744 |
---|---|
Provider Name | Henry Gursky |
First Address | Allentown, PA 18104-4697 |
Second Address | Allentown, PA 18106-9042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2016 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1034854360001 | (05) | PA |