MEDICARE: DR. ELIZABETH BJICK-LARSEN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS016138	PA

General Provider Information

NPI Number	:	1184222929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH BJICK-LARSEN PH.D.

Provider Business Mailing Address
First Line	:	513 BRYN MAWR AVE
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-2412
Country	:	US
Telephone Number	:	610-544-3025
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 S CHESTER RD STE 4
Second Line	:
City	:	SWARTHMORE
State	:	PA
Zip	:	19081-1919
Country	:	US
Telephone Number	:	484-597-1122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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