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General NPI Number Information
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NPI Number | 1326315904
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Entity Type | Individual
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Provider Name | SHOSHANA WORTMAN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/26/2011
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Last Update Date | 10/21/2022
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Provider Practice Location Address
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Address Line | 583 SKIPPACK PIKE STE 410
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City | BLUE BELL
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State | PA
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Zip | 19422-2146
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Country | US
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Telephone | 267-289-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 SHAWNEE GRN
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City | AMBLER
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State | PA
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Zip | 19002-3638
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Country | US
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Telephone | 215-341-1738
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017124
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License Number State | PA
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