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General NPI Number Information
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NPI Number | 1700430170
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Entity Type | Individual
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Provider Name | EMMA WOODS NATHANSON PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2019
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 1373 W 6TH ST
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City | ERIE
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State | PA
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Zip | 16505-2503
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Country | US
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Telephone | 814-612-4141
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 ELLSWORTH AVE
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City | ERIE
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State | PA
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Zip | 16508-2140
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Country | US
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Telephone | 814-566-7744
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6352000564
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6362002863
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 6352000564
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS020003
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License Number State | PA
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