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General NPI Number Information
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NPI Number | 1932683554
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Entity Type | Individual
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Provider Name | AMELIA DAWN SERINE PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/19/2018
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Last Update Date | 09/19/2018
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Provider Practice Location Address
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Address Line | 270 LANCASTER AVE BLDG J
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City | MALVERN
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State | PA
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Zip | 19355-1858
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Country | US
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Telephone | 484-800-1488
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Fax |
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Provider Business Mailing Address
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Address Line | 20 WAVERLY RD
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City | HAVERTOWN
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State | PA
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Zip | 19083-4532
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Country | US
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Telephone | 484-269-4089
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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 | PS018623
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License Number State | PA
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