Doctor Name: | DR. MARK S. KISELICA |
NPI Number: | 1073623062 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 37PC00226600 |
Business Practice Address: | 41 Copperleaf Dr Newtown, PA - 189401782 |
Business Phone Number: | 2158605964 |
Business Fax Number: | |
Mailing Address: | 41 Copperleaf Dr, NEWTOWN |
State: | PA |
Postal Code: | 189401782 |
Phone Number: | 2158605964 |
Fax Number: | |
NPI Enumeration Date: | 08/30/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 37PC00226600 |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | NJ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |