Healthcare Provider Details

I. General information

NPI: 1467902189
Provider Name (Legal Business Name): ANDREA JOAN LIST PERELMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 FORREST AVE
NARBERTH PA
19072-1805
US

IV. Provider business mailing address

218 FORREST AVE
NARBERTH PA
19072-1805
US

V. Phone/Fax

Practice location:
  • Phone: 917-204-0277
  • Fax:
Mailing address:
  • Phone: 917-204-0277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: