Healthcare Provider Details

I. General information

NPI: 1841589421
Provider Name (Legal Business Name): PAMELA MILLER LUNARDI, PSY.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 TOWNSHIP LINE RD
DREXEL HILL PA
19026-1925
US

IV. Provider business mailing address

3350 TOWNSHIP LINE RD
DREXEL HILL PA
19026-1925
US

V. Phone/Fax

Practice location:
  • Phone: 610-853-8231
  • Fax: 610-853-8238
Mailing address:
  • Phone: 610-853-8231
  • Fax: 610-853-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberPS016448
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberPS016448
License Number StatePA

VIII. Authorized Official

Name: DR. PAMELA MILLER LUNARDI
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 610-853-8231