Healthcare Provider Details

I. General information

NPI: 1568810869
Provider Name (Legal Business Name): ELANA SZCZESNY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4812 BALTIMORE AVE APT 3R
PHILADELPHIA PA
19143-3419
US

IV. Provider business mailing address

4812 BALTIMORE AVE APT 3R
PHILADELPHIA PA
19143-3419
US

V. Phone/Fax

Practice location:
  • Phone: 301-641-9548
  • Fax: 215-823-4123
Mailing address:
  • Phone: 301-641-9548
  • Fax: 215-823-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018043
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: