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General NPI Number Information
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NPI Number | 1932320116
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Entity Type | Individual
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Provider Name | JEROME FRANCIS KNAST PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 133 HEATHER RD SUITE 100
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City | BALA CYNWYD
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State | PA
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Zip | 19004-3009
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Country | US
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Telephone | 215-601-1413
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Fax |
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Provider Business Mailing Address
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Address Line | 2227 WALLACE ST
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City | PHILADELPHIA
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State | PA
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Zip | 19130-3125
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Country | US
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Telephone | 215-232-1417
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Fax | 856-384-1512
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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 | PS003306L
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License Number State | PA
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