Healthcare Provider Details

I. General information

NPI: 1184802654
Provider Name (Legal Business Name): DAGMAWI DAGNEW PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BLACKHORSE HILL RD
COATESVILLE PA
19320-2096
US

IV. Provider business mailing address

1400 BLACKHORSE HILL RD
COATESVILLE PA
19320-2040
US

V. Phone/Fax

Practice location:
  • Phone: 610-384-7711
  • Fax:
Mailing address:
  • Phone: 610-384-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017897
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: