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General NPI Number Information
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NPI Number | 1497420558
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Entity Type | Individual
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Provider Name | THERESA EGAN PHD
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Gender | Female
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 323 E FRONT ST
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City | MEDIA
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State | PA
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Zip | 19063-3036
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Country | US
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Telephone | 267-551-1984
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Fax |
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Provider Business Mailing Address
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Address Line | 230 SULKY WAY
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City | CHADDS FORD
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State | PA
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Zip | 19317-8908
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Country | US
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Telephone | 302-893-2671
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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 | PS019346
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License Number State | PA
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