Healthcare Provider Details

I. General information

NPI: 1730176025
Provider Name (Legal Business Name): NANCY ACKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2005
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 STREET RD STE 101
SOUTHAMPTON PA
18966-4250
US

IV. Provider business mailing address

4230 MORRIS RD
HATBORO PA
19040-2513
US

V. Phone/Fax

Practice location:
  • Phone: 215-773-8425
  • Fax:
Mailing address:
  • Phone: 215-773-9977
  • Fax: 215-773-8425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS004525L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPS004525L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPS004525L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS004525L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS004525L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPS004525L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPS004525L
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPS004525L
License Number StatePA
# 9
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS004525L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: