MEDICARE: DR. DOROTHEA COLAVITA 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	103TC1900X	Counseling Psychologist	PS-16014	PA

General Provider Information

NPI Number	:	1275587321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHEA COLAVITA PH.D.

Provider Business Mailing Address
First Line	:	1761 DOLINGTON RD
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-2607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 S DELAWARE AVE
Second Line	:	SUITE 203B-2
City	:	YARDLEY
State	:	PA
Zip	:	19067-1524
Country	:	US
Telephone Number	:	215-208-9917
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	10/03/2016

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