Provider Demographics
NPI:1447381785
Name:MINER-ISAACSON, ANDREA DALE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:DALE
Last Name:MINER-ISAACSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 HEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-5539
Mailing Address - Country:US
Mailing Address - Phone:610-446-4981
Mailing Address - Fax:610-446-4298
Practice Address - Street 1:822 MONTGOMERY AVE
Practice Address - Street 2:#301
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1937
Practice Address - Country:US
Practice Address - Phone:610-664-1424
Practice Address - Fax:610-664-1424
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005844L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0469820000OtherPERSONAL CHOICE
PAIS639543Medicare ID - Type Unspecified