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General NPI Number Information
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NPI Number | 1417157579
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Entity Type | Individual
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Provider Name | EDWARD J DICESARE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1062 E LANCASTER AVE SUITE 26A
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City | BRYN MAWR
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State | PA
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Zip | 19010-1552
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Country | US
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Telephone | 610-527-4626
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Fax | 610-356-4697
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Provider Business Mailing Address
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Address Line | 1062 E LANCASTER AVE SUITE 26A
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City | BRYN MAWR
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State | PA
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Zip | 19010-1552
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Country | US
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Telephone | 610-527-4626
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Fax | 610-356-4697
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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 | PS003659-L
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License Number State | PA
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