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General NPI Number Information
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NPI Number | 1801242185
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Entity Type | Organization
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Legal Business Name | CONTEMPORARY TMS OF BRYNMAWR
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Dates
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Enumeration Date | 05/05/2016
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 940 E HAVERFORD RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-3845
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Country | US
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Telephone | 610-520-1128
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Fax |
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Provider Business Mailing Address
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Address Line | 940 E HAVERFORD RD
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City | BRYN MAWR
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State | PA
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Zip | 19010-3845
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Country | US
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Telephone | 610-520-1128
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Fax |
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Authorized Official
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Title or Position | SUPERVISOR
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Name | MS. ELLEN WANG
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Credential |
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Telephone | 856-334-8596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 039232
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License Number State | CT
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