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General NPI Number Information
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NPI Number | 1801126990
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Entity Type | Organization
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Legal Business Name | MAIN LINE PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 300 E LANCASTER AVE STE 306B
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City | WYNNEWOOD
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State | PA
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Zip | 19096-2106
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Country | US
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Telephone | 610-649-2956
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Fax |
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Provider Business Mailing Address
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Address Line | 1607 WINSTON RD
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City | GLADWYNE
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State | PA
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Zip | 19035-1251
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Country | US
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Telephone | 610-649-2956
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. DENA SOLOMON
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Credential | PH.D.
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Telephone | 610-649-2956
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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 | PS-006305-L
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License Number State | PA
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