Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS017696 | PA |
Y | 103TC0700X | Clinical Psychologist | PS017696 | PA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PS017696 | PA |
N | 103TM1800X | Intellectual & Developmental Disabilities | PS017696 | PA |
NPI | 1033512736 |
---|---|
Provider Name | Dr. Todd Koser |
First Address | Cherry Hill, NJ 08003-4106 |
Second Address | Cherry Hill, NJ 08003-4106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2014 |
Last Update Date | 11/08/2017 |