Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | #1-07-3652 | PA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PS006978L | PA |
NPI | 1174533806 |
---|---|
Provider Name | Mary Christine Remick |
First Address | Dalton, PA 18414-9610 |
Second Address | Clarks Summit, PA 18411-1684 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 17/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
#1-07-3652 | BEHAVIOR ANALYTIC CERTIFICATION BOARD (01) | PA |
PS006978L | PSYCHOLOGIST LICENSE (01) | PA |