MEDICARE: DR. LAURA STANTON PH.D.

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	PS008623L	PA

General Provider Information

NPI Number	:	1699815878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA STANTON PH.D.

Provider Business Mailing Address
First Line	:	401 E WILLOW GROVE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-2915
Country	:	US
Telephone Number	:	215-247-2843
Fax Number	:	215-247-5817

Provider Business Practice Location Address
First Line	:	505 YORK RD
Second Line	:	SUITE 100
City	:	JENKINTOWN
State	:	PA
Zip	:	19046-2136
Country	:	US
Telephone Number	:	215-247-2843
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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