Healthcare Provider Details

I. General information

NPI: 1659778967
Provider Name (Legal Business Name): NADANIEL EADDY JR. LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8721 WISSAHICKON AVE
PHILADELPHIA PA
19128-1124
US

IV. Provider business mailing address

8721 WISSAHICKON AVE
PHILADELPHIA PA
19128-1124
US

V. Phone/Fax

Practice location:
  • Phone: 609-531-5374
  • Fax:
Mailing address:
  • Phone: 609-531-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMF001273
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: