MEDICARE: DR. FAITH VAL DYSON-WASHINGTON 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	PS017207	PA

General Provider Information

NPI Number	:	1699927095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FAITH VAL DYSON-WASHINGTON PH.D.

Provider Business Mailing Address
First Line	:	2005 MARKET ST
Second Line	:	SUITE 3140
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7042
Country	:	US
Telephone Number	:	215-636-9797
Fax Number	:	215-636-9979

Provider Business Practice Location Address
First Line	:	2005 MARKET ST
Second Line	:	SUITE 3140
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-7042
Country	:	US
Telephone Number	:	215-636-9797
Fax Number	:	215-636-9979

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	12/17/2015

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