Healthcare Provider Details

I. General information

NPI: 1265525323
Provider Name (Legal Business Name): ANTHONY C. TZOUMAS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 RIDGEWOOD ROAD SUITE 400
WYOMISSING PA
19610-6977
US

IV. Provider business mailing address

2201 RIDGEWOOD ROAD SUITE 400
WYOMISSING PA
19610-6977
US

V. Phone/Fax

Practice location:
  • Phone: 610-378-9601
  • Fax: 610-378-3610
Mailing address:
  • Phone: 610-378-9601
  • Fax: 610-378-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS015292
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPS015292
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPS015292
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPS015292
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: