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General NPI Number Information
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NPI Number | 1598334245
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Entity Type | Individual
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Provider Name | ALICE H THORNEWILL PHD, JD
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Gender | Female
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 1802 GREEN ST APT 3
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City | PHILADELPHIA
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State | PA
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Zip | 19130-4017
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Country | US
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Telephone | 844-287-4228
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Fax |
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Provider Business Mailing Address
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Address Line | 578 WASHINGTON BLVD # 1162
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5421
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Country | US
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Telephone | 502-386-7517
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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 | PSY-19249
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License Number State | PA
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