Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PS004201L | PA |
N | 103TC0700X | Clinical Psychologist | PS004201L | PA |
N | 103TA0700X | Adult Development & Aging Psychologist | PS004201L | PA |
NPI | 1174502371 |
---|---|
Provider Name | Dr. Brenda Ivker |
First Address | Philadelphia, PA 19148 |
Second Address | Philadelphia, PA 19148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R07148 | (02) |