Provider Demographics
NPI:1043500176
Name:DR. PATRICIA A CHESLOCK, PC
Entity type:Organization
Organization Name:DR. PATRICIA A CHESLOCK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CHESLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-421-7100
Mailing Address - Street 1:804 SARAH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1738
Mailing Address - Country:US
Mailing Address - Phone:570-421-7100
Mailing Address - Fax:570-420-1248
Practice Address - Street 1:804 SARAH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1738
Practice Address - Country:US
Practice Address - Phone:570-421-7100
Practice Address - Fax:570-420-1248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016434103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA82336OtherFIRST PRIORITY HEALTH
PA002050173OtherHIGHMARK BLUE SHIELD
PA002050173OtherFPLIC TRADITIONAL
PA102219041 0001Medicaid
PA002050173OtherFPLIC TRADITIONAL