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General NPI Number Information
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NPI Number | 1326513961
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Entity Type | Individual
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Provider Name | JULIE PRESENT KOLLER
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Gender | Female
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Dates
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Enumeration Date | 10/10/2018
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Last Update Date | 10/10/2018
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Provider Practice Location Address
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Address Line | 2043 LOCUST ST FL 1A
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City | PHILADELPHIA
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State | PA
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Zip | 19103-5662
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Country | US
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Telephone | 610-816-0031
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Fax | 215-600-3525
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Provider Business Mailing Address
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Address Line | 1419 RYDAL RD
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City | RYDAL
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State | PA
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Zip | 19046-1216
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Country | US
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Telephone | 650-996-1757
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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 | PS018656
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License Number State | PA
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