Healthcare Provider Details

I. General information

NPI: 1548330798
Provider Name (Legal Business Name): DAVID KANNERSTEIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 OLD YORK RD SUITE 203
JENKINTOWN PA
19046-3925
US

IV. Provider business mailing address

4103 FOUNTAIN GREEN RD
LAFAYETTE HILL PA
19444-1214
US

V. Phone/Fax

Practice location:
  • Phone: 215-885-3337
  • Fax: 215-885-3090
Mailing address:
  • Phone: 215-680-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSOO6413-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: