Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS005140L | PA |
Y | 103TC0700X | Clinical Psychologist | PS005140L | PA |
N | 103TR0400X | Rehabilitation Psychologist | PS005140L | PA |
NPI | 1386744001 |
---|---|
Provider Name | Marcia Gail Hochberg |
First Address | Malvern, PA 19355 |
Second Address | Malvern, PA 19355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 15/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R83501 | (02) |