MEDICARE: NINA KASSER SIDELL

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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1992357263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NINA KASSER SIDELL

Provider Business Mailing Address
First Line	:	1601 HEARD DR
Second Line	:
City	:	MAPLE GLEN
State	:	PA
Zip	:	19002-3163
Country	:	US
Telephone Number	:	215-628-0282
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 HEARD DR
Second Line	:
City	:	MAPLE GLEN
State	:	PA
Zip	:	19002-3163
Country	:	US
Telephone Number	:	215-628-0282
Fax Number	:

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

Provider Enumeration Date	:	07/16/2019
Last Update Date	:	07/16/2019

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Directions to “ NINA KASSER SIDELL ” Practice Location

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