Healthcare Provider Details

I. General information

NPI: 1386025989
Provider Name (Legal Business Name): RONALD S. KAISER, PH.D., ABPP& ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WALNUT ST SUITE 200
PHILADELPHIA PA
19107-5509
US

IV. Provider business mailing address

900 WALNUT ST SUITE 200
PHILADELPHIA PA
19107-5509
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-2097
  • Fax:
Mailing address:
  • Phone: 215-955-2097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPS017694
License Number StatePA

VIII. Authorized Official

Name: DR. RONALD S. KAISER
Title or Position: SUPERVISING PSYCHOLOGIST
Credential: PHD, ABPP
Phone: 215-955-2743