MEDICARE: DR. DOLORES R MARCHESANO DSW LICENSED PSYCHOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS008147L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	796832	OTHER		BLUE CROSS BLUE SHIELD
2	0606079	OTHER		AETNA

General Provider Information

NPI Number	:	1497706352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOLORES R MARCHESANO DSW LICENSED PSYCHOL

Provider Business Mailing Address
First Line	:	219 SUGARTOWN ROAD
Second Line	:	UNIT H301
City	:	WAYNE
State	:	PA
Zip	:	19087-3041
Country	:	US
Telephone Number	:	610-688-6224
Fax Number	:

Provider Business Practice Location Address
First Line	:	426 PENNSYLVANIA AVENUE
Second Line	:	SUITE 201
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3410
Country	:	US
Telephone Number	:	610-519-0113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	07/08/2007

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