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General NPI Number Information
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NPI Number | 1700149168
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Entity Type | Individual
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Provider Name | JOHN D GUERRY PH.D.
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 119 COULTER AVE STE 213
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City | ARDMORE
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State | PA
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Zip | 19003-2427
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Country | US
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Telephone | 267-388-1325
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Fax |
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Provider Business Mailing Address
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Address Line | 333 E LANCASTER AVE STE 197
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City | WYNNEWOOD
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State | PA
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Zip | 19096-1929
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Country | US
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Telephone | 302-635-0864
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS017652
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License Number State | PA
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