Provider Demographics
NPI:1225013360
Name:JONAS, AGNES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:JONAS
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 1:22 RIDERS RUN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3024
Mailing Address - Country:US
Mailing Address - Phone:610-883-6183
Mailing Address - Fax:610-882-2072
Practice Address - Street 1:22 RIDERS RUN
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3024
Practice Address - Country:US
Practice Address - Phone:610-883-6183
Practice Address - Fax:610-883-6183
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015773103T00000X, 103G00000X, 103TH0004X, 103TR0400X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2365736000OtherINDEPENDENCE BLUE CROSS
PA50054721OtherCAPITAL BLUE CROSS
PA556259000OtherMAGELLAN BEHAVIORAL HEALT
PAP00263821OtherRAIL ROAD MEDICARE
PAJO1769808OtherHIGHMARK
PA096431K1SMedicare ID - Type Unspecified