Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS019183 | PA |
Y | 103T00000X | Psychologist | PS019183 | PA |
N | 103TH0100X | Health Service |
NPI | 1417444746 |
---|---|
Provider Name | Samuel A Faulkner |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-9800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2018 |
Last Update Date | 23/12/2020 |