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General NPI Number Information
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NPI Number | 1407826431
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Entity Type | Individual
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Provider Name | CAROL A. GANTMAN PH. D.
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Gender | Female
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 29 BALA AVE SUITE 224
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3209
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Country | US
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Telephone | 610-667-7280
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Fax | 610-667-7141
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Provider Business Mailing Address
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Address Line | 29 BALA AVE SUITE 224
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3209
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Country | US
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Telephone | 610-667-7280
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Fax | 610-667-7141
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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 | PS002422L
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License Number State | PA
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