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General NPI Number Information
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NPI Number | 1265651699
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Entity Type | Individual
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Provider Name | LINDA K WANTMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 187 FOX RUN RD
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City | LOWER GWYNEDD
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State | PA
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Zip | 19002-2050
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Country | US
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Telephone | 215-793-0397
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Fax | 215-641-4978
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Provider Business Mailing Address
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Address Line | 187 FOX RUN RD.
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City | LOWER GWYNEDD
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State | PA
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Zip | 19002-2050
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Country | US
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Telephone | 215-793-0397
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Fax | 215-641-4978
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PS005082L
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License Number State | PA
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