| NPI | 1588628903 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK S. WAGNER Director 215-331-7707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-003973-L) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2020-08-22 |