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NPI Code Detail

MEDICARE: MS. MARTHA MARY DI PRINZIO MA

MEDICARE: MS. MARTHA MARY DI PRINZIO MA
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
1103T00000XPsychologistPS006760-LPA

General Provider Information

NPI Number : 1720102650
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARTHA MARY DI PRINZIO MA
Provider Business Mailing Address
First Line : 79 FENTON DR
Second Line :
City : CARNEYS POINT
State : NJ
Zip : 08069-2834
Country : US
Telephone Number : 856-351-0351
Fax Number : 610-534-2907
Provider Business Practice Location Address
First Line : 848 W KINGS HWY
Second Line :
City : COATESVILLE
State : PA
Zip : 19320-1714
Country : US
Telephone Number : 610-524-8701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2007
Last Update Date : 05/11/2017

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