Healthcare Provider Details

I. General information

NPI: 1851504575
Provider Name (Legal Business Name): ANDREW THOMAS WOLANIN PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 WEST OLNEY AVE, BOX 271 LA SALLE UNIVERSITY
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

4132 MANAYUNK AVE
PHILADELPHIA PA
19128-5028
US

V. Phone/Fax

Practice location:
  • Phone: 215-991-3518
  • Fax:
Mailing address:
  • Phone: 215-991-3518
  • Fax: 215-951-1351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS016068
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016068
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License NumberPS016068
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: