Provider Demographics
NPI:1326315904
Name:WORTMAN, SHOSHANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:
Last Name:WORTMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 SHAWNEE GRN
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3638
Mailing Address - Country:US
Mailing Address - Phone:215-341-1738
Mailing Address - Fax:
Practice Address - Street 1:583 SKIPPACK PIKE STE 410
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2146
Practice Address - Country:US
Practice Address - Phone:267-289-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-26
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical