Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS 016279 | PA |
Y | 103T00000X | Psychologist | PS 016279 | PA |
NPI | 1013101385 |
---|---|
Provider Name | Dr. Robin Michael Ward |
First Address | Philadelphia, PA 19103-4709 |
Second Address | Philadelphia, PA 19103-4709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2007 |
Last Update Date | 30/08/2007 |