Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS 007 102L | PA |
NPI | 1033126461 |
---|---|
Provider Name | Paula Thomas Delong |
First Address | Wayne, PA 19087-3204 |
Second Address | Wayne, PA 19087-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |