Healthcare Provider Details

I. General information

NPI: 1205223138
Provider Name (Legal Business Name): RAQUEL EMDUR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 W LANCASTER AVE STE 8
ARDMORE PA
19003-1413
US

IV. Provider business mailing address

PO BOX 34465
PHILADELPHIA PA
19101-4465
US

V. Phone/Fax

Practice location:
  • Phone: 215-948-4227
  • Fax: 267-200-0921
Mailing address:
  • Phone: 267-909-6544
  • Fax: 267-200-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS020030
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020030
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS020030
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS020030
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS020030
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPS020030
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS020030
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPS020030
License Number StatePA
# 10
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPS020030
License Number StatePA
# 11
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPS020030
License Number StatePA
# 12
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS020030
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: