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NPI Code Detail

MEDICARE: MYLISSA MARY SLANE PHD

MEDICARE: MYLISSA MARY SLANE PHD
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
1103TC2200XClinical Child & Adolescent Psychologist
2103TS0200XSchool Psychologist

General Provider Information

NPI Number : 1932753035
Entity Type Code : Individual
Provider Name (Legal Business Name) : MYLISSA MARY SLANE PHD
Provider Business Mailing Address
First Line : 734 CHERYL DR
Second Line :
City : WARMINSTER
State : PA
Zip : 18974-2135
Country : US
Telephone Number : 215-817-6849
Fax Number :
Provider Business Practice Location Address
First Line : 2801 GRANT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-1032
Country : US
Telephone Number : 215-878-3400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2019
Last Update Date : 01/19/2023

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