Provider Demographics
NPI:1245396563
Name:VANBUREN, AGNES (MA)
Entity Type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:VANBUREN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SUMMIT SQUARE CTR
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1078
Mailing Address - Country:US
Mailing Address - Phone:215-949-2520
Mailing Address - Fax:
Practice Address - Street 1:13 SUMMIT SQUARE CTR
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1078
Practice Address - Country:US
Practice Address - Phone:215-949-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006484L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist