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General NPI Number Information
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NPI Number | 1245554674
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Entity Type | Individual
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Provider Name | AVIELE MELISSA KOFFLER PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/14/2010
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Last Update Date | 03/14/2010
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Provider Practice Location Address
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Address Line | 201 E GERMANTOWN PIKE
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1550
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Country | US
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Telephone | 610-834-1671
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Fax |
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Provider Business Mailing Address
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Address Line | 155 TIMOTHY CIR
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City | RADNOR
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State | PA
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Zip | 19087-4647
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Country | US
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Telephone | 215-901-9512
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS016756
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016756
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | PS016756
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License Number State | PA
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