Healthcare Provider Details

I. General information

NPI: 1649536657
Provider Name (Legal Business Name): DANIEL DEUTSCH LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 E MOUNT AIRY AVE
PHILADELPHIA PA
19119-1713
US

IV. Provider business mailing address

27 E MOUNT AIRY AVE
PHILADELPHIA PA
19119-1713
US

V. Phone/Fax

Practice location:
  • Phone: 215-510-7055
  • Fax:
Mailing address:
  • Phone: 215-510-7055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF000658
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: