Provider Demographics
NPI:1407971294
Name:COTTERELL, NORMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:
Last Name:COTTERELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BELMONT AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1617
Mailing Address - Country:US
Mailing Address - Phone:610-664-3020
Mailing Address - Fax:
Practice Address - Street 1:1 BELMONT AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1617
Practice Address - Country:US
Practice Address - Phone:610-664-3020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005966L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA674636Medicare ID - Type UnspecifiedPROVIDER NUMBER