Healthcare Provider Details

I. General information

NPI: 1750103461
Provider Name (Legal Business Name): PAOLI PSYCHOLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 LEOPARD RD STE 200
PAOLI PA
19301-1552
US

IV. Provider business mailing address

43 LEOPARD RD STE 200
PAOLI PA
19301-1552
US

V. Phone/Fax

Practice location:
  • Phone: 610-644-8182
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MORGAN
Title or Position: PSYD
Credential:
Phone: 610-644-8182