Healthcare Provider Details

I. General information

NPI: 1487846812
Provider Name (Legal Business Name): JAIME SPINELL ZUCKERMAN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAIME SHANNON SPINELL PSY.D.

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 E HAVERFORD RD SUITE 306-B
BRYN MAWR PA
19010-3850
US

IV. Provider business mailing address

950 E HAVERFORD RD SUITE 306-B
BRYN MAWR PA
19010-3850
US

V. Phone/Fax

Practice location:
  • Phone: 610-551-1819
  • Fax: 484-532-7782
Mailing address:
  • Phone: 610-551-1819
  • Fax: 484-532-7782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: