Organization Name: | MILTON H ERICKSON INSTITUTE OF PHILADELPHIA |
NPI Number: | 1063718450 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN EDGETTE (OWNER) |
Mailing Address: | 660 Exton Cmns Exton |
State: | PA US |
Postal Code: | 193412446 |
Phone Number: | 6103638717 |
Fax Number: | 6104308307 |
NPI Enumeration Date: | 02/01/2011 |
NPI Last Update Date: | 02/01/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |