Provider Demographics
NPI:1093818080
Name:BACKAL, PEGGY CAREN (PSYD)
Entity Type:Individual
Prefix:MS
First Name:PEGGY
Middle Name:CAREN
Last Name:BACKAL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20134 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1112
Mailing Address - Country:US
Mailing Address - Phone:610-878-9330
Mailing Address - Fax:267-552-1002
Practice Address - Street 1:8220 CASTOR AVENUE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-728-4188
Practice Address - Fax:267-350-4887
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015600103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical