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General NPI Number Information
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NPI Number | 1205220159
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Entity Type | Individual
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Provider Name | EMILY KOSTELNIK PHD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 11/11/2022
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Provider Practice Location Address
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Address Line | 525 ROUTE 73 N STE 104
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City | MARLTON
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State | NJ
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Zip | 08053-3422
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 525 ROUTE 73 N STE 104
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City | MARLTON
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State | NJ
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Zip | 08053-3422
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Country | US
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Telephone | 856-485-5160
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Fax | 856-545-8746
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005623
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License Number State | VA
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