| Doctor Name: | MARNIE SUE NUTKOWITZ |
| NPI Number: | 1023153970 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSYD |
| License Number: | PS015455 |
| Business Practice Address: | 60 Township Line Rd Moss Rehab Elkins Park, PA - 190272220 |
| Business Phone Number: | 2156636000 |
| Business Fax Number: | |
| Mailing Address: | 101 E Olney Ave, Suite 505 PHILA |
| State: | PA |
| Postal Code: | 191202421 |
| Phone Number: | 2152542630 |
| Fax Number: | 2152542599 |
| NPI Enumeration Date: | 02/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PS015455 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |