Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS015773 | PA |
Y | 103TC0700X | Clinical Psychologist | PS015773 | PA |
N | 102L00000X | Psychologist | PS015773 | PA |
N | 103T00000X | Psychologist | PS015773 | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS015773 | PA |
N | 103TH0004X | Health Psychologist | PS015773 | PA |
N | 103TR0400X | Rehabilitation Psychologist | PS015773 | PA |
NPI | 1225013360 |
---|---|
Provider Name | Dr. Agnes Jonas |
First Address | Newtown Square, PA 19073-3024 |
Second Address | Newtown Square, PA 19073-3024 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 19/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2365736000 | INDEPENDENCE BLUE CROSS (01) | PA |
50054721 | CAPITAL BLUE CROSS (01) | PA |
556259000 | MAGELLAN BEHAVIORAL HEALT (01) | PA |
JO1769808 | HIGHMARK (01) | PA |
P00263821 | RAIL ROAD MEDICARE (01) | PA |