Healthcare Provider Details

I. General information

NPI: 1689184772
Provider Name (Legal Business Name): HILARY P WALLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 E LANCASTER AVE STE 2
BRYN MAWR PA
19010-1568
US

IV. Provider business mailing address

1428 GLEN ECHO LN
DRESHER PA
19025-1119
US

V. Phone/Fax

Practice location:
  • Phone: 610-525-7527
  • Fax:
Mailing address:
  • Phone: 917-324-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPC009856
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPC009856
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC009856
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: