Healthcare Provider Details

I. General information

NPI: 1770141996
Provider Name (Legal Business Name): RISING SUN PSYCHOLOGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CHESTER RD STE 4
SWARTHMORE PA
19081-1919
US

IV. Provider business mailing address

225 S CHESTER RD STE 4
SWARTHMORE PA
19081-1919
US

V. Phone/Fax

Practice location:
  • Phone: 610-883-7469
  • Fax:
Mailing address:
  • Phone: 610-883-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPS016581
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPENNSYLVANIA PSYCHOLOGY LICENSE NUMBER
# 2
Identifier1841492667
Identifier TypeOTHER
Identifier State
Identifier IssuerSOLE PROVIDER TYPE 1 NPI

VIII. Authorized Official

Name: DR. HAL S SHOREY
Title or Position: CEO
Credential: PH.D.
Phone: 610-883-7469