Healthcare Provider Details

I. General information

NPI: 1649214271
Provider Name (Legal Business Name): TALYA L ESCOGIDO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 WALNUT ST STE 2323
PHILADELPHIA PA
19103-4708
US

IV. Provider business mailing address

1810 RITTENHOUSE SQ #908
PHILADELPHIA PA
19103-5816
US

V. Phone/Fax

Practice location:
  • Phone: 215-735-0595
  • Fax: 215-735-7970
Mailing address:
  • Phone: 215-735-0595
  • Fax: 215-735-7970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005368L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: