Provider Demographics
NPI:1346684602
Name:GAIL VANT ZELFDE, PH.D., LLC
Entity Type:Organization
Organization Name:GAIL VANT ZELFDE, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VANT ZELFDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-941-0196
Mailing Address - Street 1:158 E BUTLER AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4436
Mailing Address - Country:US
Mailing Address - Phone:610-941-0196
Mailing Address - Fax:
Practice Address - Street 1:158 E BUTLER AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-4436
Practice Address - Country:US
Practice Address - Phone:610-941-0196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005338L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001661409OtherAMERIHEALTH
PA5616328OtherAETNA
PA0261731000OtherPERSONAL CHOICE
PA487643000OtherMAGELLAN
PA466001OtherBLUE CROSS BLUE SHIELD