Doctor Name: | MR. MARK O'DWYER |
NPI Number: | 1013258763 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | PC00006787 |
Business Practice Address: | 403 W Lincoln Hwy Suite 206 Exton, PA - 193412559 |
Business Phone Number: | 6103632088 |
Business Fax Number: | |
Mailing Address: | 315 Gates St, PHILADELPHIA |
State: | PA |
Postal Code: | 191284618 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/05/2013 |
NPI Last Update Date: | 03/05/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | PC00006787 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |