MEDICARE: CHRISTINA IMO CARSON-SACCO PSY.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	PS016420	PA

General Provider Information

NPI Number	:	1932374212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA IMO CARSON-SACCO PSY.D.

Provider Business Mailing Address
First Line	:	405 MADISON AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-1509
Country	:	US
Telephone Number	:	215-793-4151
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 MADISON AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-1509
Country	:	US
Telephone Number	:	215-793-4151
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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