Healthcare Provider Details

I. General information

NPI: 1699927095
Provider Name (Legal Business Name): FAITH VAL DYSON-WASHINGTON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 12/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 MARKET ST SUITE 3140
PHILADELPHIA PA
19103-7042
US

IV. Provider business mailing address

2005 MARKET ST SUITE 3140
PHILADELPHIA PA
19103-7042
US

V. Phone/Fax

Practice location:
  • Phone: 215-636-9797
  • Fax: 215-636-9979
Mailing address:
  • Phone: 215-636-9797
  • Fax: 215-636-9979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS017207
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: