Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS016033 | PA |
NPI | 1083767172 |
---|---|
Provider Name | Dr. John Wesley Bishop JR. |
First Address | Philadelphia, PA 19129-1508 |
Second Address | Philadelphia, PA 19107-1111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |