Provider Demographics
NPI:1316032576
Name:HERMOSISIMA, ERNESTO CELI (EDD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:CELI
Last Name:HERMOSISIMA
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 E WYNNEWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096
Mailing Address - Country:US
Mailing Address - Phone:610-642-8890
Mailing Address - Fax:610-642-8986
Practice Address - Street 1:1 E WYNNEWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-642-8890
Practice Address - Fax:610-642-8986
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist