Healthcare Provider Details

I. General information

NPI: 1831294818
Provider Name (Legal Business Name): JOSEPH FREDRICK FOOTE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PRESIDENTIAL BLVD SUITE 204 BALA PROFESSIONAL OFFICES
BALA CYNWYD PA
19004
US

IV. Provider business mailing address

1218 CHESTNUT STREET #607
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-625-9655
  • Fax: 215-625-8524
Mailing address:
  • Phone: 215-625-9655
  • Fax: 215-625-8524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS004668L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: