Healthcare Provider Details

I. General information

NPI: 1992034417
Provider Name (Legal Business Name): EMILY ANN MCKENNA-MATTSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2009
Last Update Date: 12/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HUMPHREYS RD
ARDMORE PA
19003-2038
US

IV. Provider business mailing address

760 HUMPHREYS RD
ARDMORE PA
19003-2038
US

V. Phone/Fax

Practice location:
  • Phone: 610-658-2345
  • Fax:
Mailing address:
  • Phone: 610-658-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: