Healthcare Provider Details

I. General information

NPI: 1114620465
Provider Name (Legal Business Name): JAMIE VANARTSDALEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 LANCASTER AVE STE 110
BERWYN PA
19312-1341
US

IV. Provider business mailing address

1199 LANCASTER AVE STE 110
BERWYN PA
19312-1341
US

V. Phone/Fax

Practice location:
  • Phone: 610-241-4331
  • Fax:
Mailing address:
  • Phone: 610-241-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS019818
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: