Provider Demographics
NPI:1265651699
Name:WANTMAN, LINDA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:K
Last Name:WANTMAN
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 1:187 FOX RUN RD.
Mailing Address - Street 2:
Mailing Address - City:LOWER GWYNEDD
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2050
Mailing Address - Country:US
Mailing Address - Phone:215-793-0397
Mailing Address - Fax:215-641-4978
Practice Address - Street 1:187 FOX RUN RD
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2050
Practice Address - Country:US
Practice Address - Phone:215-793-0397
Practice Address - Fax:215-641-4978
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005082L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling