Provider Demographics
NPI:1417157579
Name:DICESARE, EDWARD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:DICESARE
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 1:1062 E LANCASTER AVE
Mailing Address - Street 2:SUITE 26A
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1552
Mailing Address - Country:US
Mailing Address - Phone:610-527-4626
Mailing Address - Fax:610-356-4697
Practice Address - Street 1:1062 E LANCASTER AVE
Practice Address - Street 2:SUITE 26A
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1552
Practice Address - Country:US
Practice Address - Phone:610-527-4626
Practice Address - Fax:610-356-4697
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003659-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist