| NPI | 1649525627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY C. RICHARDS Authorized Representative 215-509-6826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2013-04-10 |