Provider Demographics
NPI:1316002009
Name:TAX, ANNE W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:W
Last Name:TAX
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 1:1656 SUSQUEHANNA RD
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1431
Mailing Address - Country:US
Mailing Address - Phone:215-887-8188
Mailing Address - Fax:215-887-9033
Practice Address - Street 1:9733 BUSTLETON AVE
Practice Address - Street 2:SUITE 2N
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-3201
Practice Address - Country:US
Practice Address - Phone:215-887-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006053L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0510104000OtherPERSONAL CHOICE
PATA676609OtherHIGHMARK BLUE CROSS
PA0510104000OtherPERSONAL CHOICE
PATA676609OtherHIGHMARK BLUE CROSS