Provider Demographics
NPI:1063492635
Name:TRUESDALE, CAROLYN (PHD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 WISSAHICKON AVE
Mailing Address - Street 2:SUITE 118 BOX 110
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19144-4248
Mailing Address - Country:US
Mailing Address - Phone:215-298-0417
Mailing Address - Fax:215-298-0502
Practice Address - Street 1:3205 DEFENSE TER
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1110
Practice Address - Country:US
Practice Address - Phone:215-843-9729
Practice Address - Fax:215-843-7313
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015386103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist