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General NPI Number Information
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NPI Number | 1780896787
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Entity Type | Individual
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Provider Name | MARIANNE E. INTOCCIA PHD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 426 PENNSYLVANIA AVE. SUITE 101
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City | FORT WASHINGTON
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State | PA
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Zip | 19034
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Country | US
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Telephone | 215-628-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 588 FAWNVIEW CIRCLE
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City | BLUE BELL
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State | PA
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Zip | 19422-1386
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Country | US
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Telephone | 215-661-1213
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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 | PS004932L
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License Number State | PA
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