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General NPI Number Information
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NPI Number | 1578815429
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Entity Type | Individual
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Provider Name | ANNE NOELLE NISENZON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 1528 WALNUT ST STE 1402
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City | PHILADELPHIA
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State | PA
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Zip | 19102
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Country | US
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Telephone | 267-540-8583
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Fax |
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Provider Business Mailing Address
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Address Line | 11 SILVER HILL LN
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City | VOORHEES
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State | NJ
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Zip | 08043-4731
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Country | US
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Telephone | 609-332-7530
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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 | 25172
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS017791
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License Number State | PA
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