Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PS016085 | PA |
N | 103T00000X | Psychologist | PS016085 | PA |
N | 103G00000X | Clinical Psychologist | PS016085 | PA |
N | 103TC0700X | Clinical Psychologist | PS016085 | PA |
Y | 103TC1900X | Counseling Psychologist | PS016085 | PA |
N | 103TF0000X | Family Psychologist | PS016085 | PA |
N | 103TP2701X | Group Psychotherapist | PS016085 | PA |
NPI | 1053498386 |
---|---|
Provider Name | Dr. Yvonne Martinez Thorne |
First Address | Philadelphia, PA 19118-2839 |
Second Address | East Norriton, PA 19401-1512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 14/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
498389501 | (05) | MO |
S70768 | (02) | MO |