Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PA018535 | PA |
Y | 103TC0700X | Clinical Psychologist | PA018535 | PA |
NPI | 1003380395 |
---|---|
Provider Name | Dr. Maria Drvoshanov |
First Address | Philadelphia, PA 19107-2469 |
Second Address | Philadelphia, PA 19102-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2019 |
Last Update Date | 19/01/2019 |