Healthcare Provider Details

I. General information

NPI: 1285955450
Provider Name (Legal Business Name): NICOLE LYNN SCHWARTZ PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1518 WALNUT ST STE 307
PHILADELPHIA PA
19102-3402
US

IV. Provider business mailing address

1518 WALNUT ST STE 307
PHILADELPHIA PA
19102-3402
US

V. Phone/Fax

Practice location:
  • Phone: 215-625-9655
  • Fax:
Mailing address:
  • Phone: 215-625-9655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016771
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number9638967
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: