Healthcare Provider Details

I. General information

NPI: 1699889295
Provider Name (Legal Business Name): DOLORES M MIHALICH PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GERMANTOWN PIKE
LAFAYETTE HILL PA
19444-1800
US

IV. Provider business mailing address

417 S 11TH ST
PHILADELPHIA PA
19147-1243
US

V. Phone/Fax

Practice location:
  • Phone: 610-825-4450
  • Fax: 610-941-5532
Mailing address:
  • Phone: 610-825-4450
  • Fax: 610-941-5532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS008736L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: