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General NPI Number Information
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NPI Number | 1659720738
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Entity Type | Organization
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Legal Business Name | EMOTIONAL WELLNESS CLINIC PLLC
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 3720 SPRUCE ST # 418
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4115
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Country | US
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Telephone | 215-600-3557
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Fax | 215-600-3557
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Provider Business Mailing Address
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Address Line | 3720 SPRUCE ST # 418
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4115
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Country | US
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Telephone | 215-600-3557
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Fax | 215-600-3557
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. PETER MATTHEW VERNIG
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Credential | PHD
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Telephone | 215-600-3557
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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 | PS017475
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License Number State | PA
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