Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | PA |
NPI | 1003416959 |
---|---|
Provider Name | Ronald Dean |
First Address | Towanda, PA 18848-9733 |
Second Address | Wysox, PA 18854-7708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2020 |
Last Update Date | 29/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NONE | NONE (01) | PA |