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General NPI Number Information
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NPI Number | 1164487500
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Entity Type | Organization
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Legal Business Name | PHYLLIS H. GOLTRA, P.C.
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 06/01/2009
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Provider Practice Location Address
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Address Line | 1616 WALNUT ST SUITE 1616
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5313
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Country | US
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Telephone | 215-545-8441
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Fax | 215-985-1129
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Provider Business Mailing Address
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Address Line | 1616 WALNUT ST SUITE 1616
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5313
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Country | US
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Telephone | 215-545-8441
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Fax | 215-985-1129
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHYLLIS H. GOLTRA
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Credential | PH.D.
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Telephone | 215-545-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006504L
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License Number State | PA
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