| NPI | 1104921006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA JOHNSON Office Manager 215-322-4720 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS003992L) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2020-08-22 |