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General NPI Number Information
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NPI Number | 1952449472
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Entity Type | Individual
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Provider Name | RANDALL STUART POWELL PSYD
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Gender | Male
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | ONE BALA AVENUE SUITE 305
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City | BALA CYNWYD
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State | PA
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Zip | 19004
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Country | US
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Telephone | 610-667-4652
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Fax | 610-667-6418
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Provider Business Mailing Address
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Address Line | 224 VALLEY RD
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City | MERION STATION
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State | PA
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Zip | 19066
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Country | US
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Telephone | 610-667-4652
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | DS004364L
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License Number State | PA
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