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General NPI Number Information
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NPI Number | 1831658376
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Entity Type | Organization
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Legal Business Name | DRAGONFLY PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 03/14/2019
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Provider Practice Location Address
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Address Line | 600 N JACKSON ST STE 306
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City | MEDIA
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State | PA
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Zip | 19063-2530
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Country | US
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Telephone | 484-440-9740
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 COMPUTER RD STE C15
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City | WILLOW GROVE
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State | PA
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Zip | 19090-1735
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Country | US
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Telephone | 484-440-9740
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL CASSANO
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Credential | PH.D.
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Telephone | 484-440-9740
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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 |
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License Number State |
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