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General NPI Number Information
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NPI Number | 1669746996
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Entity Type | Organization
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Legal Business Name | TAFT PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 03/05/2012
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Last Update Date | 03/05/2012
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Provider Practice Location Address
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Address Line | 3 W NEWFIELD WAY
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3304
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Country | US
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Telephone | 484-343-1841
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Fax |
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Provider Business Mailing Address
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Address Line | 3 W NEWFIELD WAY
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KAILA DICKSTEIN
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Credential | PSY.D.
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Telephone | 484-343-1841
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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 | PS016603
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License Number State | PA
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