Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 35SI00570900 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | B10001073 | DE |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PS018565 | PA |
NPI | 1003211277 |
---|---|
Provider Name | Dr. Mary Iampietro |
First Address | Philadelphia, PA 19104-4319 |
Second Address | Wilmington, DE 19803-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2014 |
Last Update Date | 06/11/2018 |