Healthcare Provider Details

I. General information

NPI: 1699335034
Provider Name (Legal Business Name): TOBY G NEEDLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 OLD EAGLE SCHOOL RD STE 719
WAYNE PA
19087-1708
US

IV. Provider business mailing address

2020 WALNUT ST APT 15L
PHILADELPHIA PA
19103-5640
US

V. Phone/Fax

Practice location:
  • Phone: 484-802-5183
  • Fax: 610-971-0144
Mailing address:
  • Phone: 484-802-5183
  • Fax: 610-971-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberCW-004223-L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberCW-004223-L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: