Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 19815703 | PA |
Y | 103T00000X | Psychologist | 19815703 | PA |
NPI | 1003884701 |
---|---|
Provider Name | Dr. Paul A Anderson |
First Address | Lykens, PA 17048-8823 |
Second Address | Lykens, PA 17048-1309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01579002 | (05) | PA |
R70638 | (02) | PA |