Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS004610L | PA |
Y | 103T00000X | Psychologist | PS004610L | PA |
N | 103TC1900X | Counseling Psychologist | PS004610L | PA |
N | 103TH0100X | Health Service | PS004610L | PA |
N | 103TR0400X | Rehabilitation Psychologist | PS004610L | PA |
NPI | 1427014281 |
---|---|
Provider Name | Dr. Joanne P. Perilstein |
First Address | Philadelphia, PA 19103-4640 |
Second Address | Philadelphia, PA 19103-4640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 18/12/2007 |