Healthcare Provider Details

I. General information

NPI: 1831922814
Provider Name (Legal Business Name): DANIEL BROSS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 N BETHLEHEM PIKE STE A1
LOWER GWYNEDD PA
19002-2109
US

IV. Provider business mailing address

311 JEFFERSON ST APT A
PLYMOUTH MEETING PA
19462-2619
US

V. Phone/Fax

Practice location:
  • Phone: 215-233-5688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS020233
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: