Healthcare Provider Details

I. General information

NPI: 1497873012
Provider Name (Legal Business Name): JOSEPH D. CAUTILLI PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 OLD BELMONT AVE
BALA CYNWYD PA
19004-1934
US

IV. Provider business mailing address

183 OLD BELMONT AVE
BALA CYNWYD PA
19004-1934
US

V. Phone/Fax

Practice location:
  • Phone: 610-664-6200
  • Fax: 610-664-6202
Mailing address:
  • Phone: 610-664-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS016410
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC001660
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: