=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992996151
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCHETYPE ENTERPRISES P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2007
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5920 HAMILTON BLVD STE 103
-----------------------------------------------------
City | ALLENTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18106
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-395-5188
-----------------------------------------------------
Fax | 610-395-5188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 CHESTNUT ST
-----------------------------------------------------
City | EMMAUS
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18049-1952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-966-5188
-----------------------------------------------------
Fax | 610-966-0466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST
-----------------------------------------------------
Name | DR. DANIEL FRANK WERNER
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 610-395-5188
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------