Healthcare Provider Details

I. General information

NPI: 1912518226
Provider Name (Legal Business Name): KAREN DYBNER-MADERO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 PENNSYLVANIA AVENUE THE PARKWAY HOUSE, SUITE 101
PHILADELPHIA PA
19130
US

IV. Provider business mailing address

436 OLD LANCASTER RD
HAVERFORD PA
19041-1518
US

V. Phone/Fax

Practice location:
  • Phone: 215-636-0887
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS009148L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: