Healthcare Provider Details

I. General information

NPI: 1093463994
Provider Name (Legal Business Name): RITA WOIDISLAWSKY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 SPRUCE ST
PHILADELPHIA PA
19103-5732
US

IV. Provider business mailing address

7900 OLD YORK RD STE 110B110B
ELKINS PARK PA
19027-2318
US

V. Phone/Fax

Practice location:
  • Phone: 267-278-0919
  • Fax:
Mailing address:
  • Phone: 267-278-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS006858
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: