Healthcare Provider Details

I. General information

NPI: 1770668865
Provider Name (Legal Business Name): MARCY B. GRINGLAS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DUPONT AT JEFFERSON-CHESTNUT 1015 CHESTNUT STREET SUITE 601
PHILADELPHIA PA
19107-4306
US

IV. Provider business mailing address

NEMOURS CHILDRENS CLINIC P.O. BOX 404112
ATLANTA GA
30384-0001
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-2664
  • Fax: 215-923-0459
Mailing address:
  • Phone: 904-390-3610
  • Fax: 904-288-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS008200L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: