Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS015680 | PA |
Y | 103TC0700X | Clinical Psychologist | PS015680 | PA |
NPI | 1013072875 |
---|---|
Provider Name | Dr. Amy Elizabeth Wenzel |
First Address | Havertown, PA 19083-5710 |
Second Address | Bryn Mawr, PA 19010-1552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 28/01/2011 |