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NPI Code Detail

MEDICARE: MR. JAMES PETER WALDRON LMFT

MEDICARE: MR. JAMES PETER WALDRON LMFT
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
1106H00000XMarriage & Family TherapistMF001032PA

General Provider Information

NPI Number : 1730713066
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAMES PETER WALDRON LMFT
Provider Business Mailing Address
First Line : 2801 GRANT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-1032
Country : US
Telephone Number : 609-576-1624
Fax Number :
Provider Business Practice Location Address
First Line : 2801 GRANT AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19114-1032
Country : US
Telephone Number : 609-576-1624
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2020
Last Update Date : 02/25/2020

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