Provider Demographics
NPI:1295837060
Name:PEARNE, SALLY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:A
Last Name:PEARNE
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 1:11 BALA AVE
Mailing Address - Street 2:BALA EXECUTIVE COMMONS #48
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3201
Mailing Address - Country:US
Mailing Address - Phone:215-842-3992
Mailing Address - Fax:
Practice Address - Street 1:11 BALA AVE
Practice Address - Street 2:BALA EXECUTIVE COMMONS #48
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3201
Practice Address - Country:US
Practice Address - Phone:215-842-3992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS001701L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0062993000OtherPERSONAL CHOICE
PA139670Medicare ID - Type UnspecifiedPROVIDER ID