Healthcare Provider Details

I. General information

NPI: 1962615930
Provider Name (Legal Business Name): LOUISE R MERVES-OKIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WASHINGTON LN SUITE 6A-2
WYNCOTE PA
19095-1403
US

IV. Provider business mailing address

THE WYNCOTR HOUSE SUITE 6A-2 25 WASHINGTON LANE
WYNCOTE PA
19095
US

V. Phone/Fax

Practice location:
  • Phone: 215-576-6523
  • Fax: 215-576-6999
Mailing address:
  • Phone: 215-576-6523
  • Fax: 215-576-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS005541-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: