Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS018177 | PA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PS018177 | PA |
Y | 103G00000X | Clinical Psychologist | PS018177 | PA |
Y | 103TC0700X | Clinical Psychologist | PS018177 | PA |
N | 103TC1900X | Counseling Psychologist | PS018177 | PA |
N | 103TF0200X | Forensic Psychologist | PS018177 | PA |
N | 103TP2701X | Group Psychotherapist | PS018177 | PA |
NPI | 1205380508 |
---|---|
Provider Name | Jonathan Krigel |
First Address | Philadelphia, PA 19103-5212 |
Second Address | Philadelphia, PA 19103-5212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2016 |
Last Update Date | 09/11/2016 |