Provider Demographics
NPI:1497706352
Name:MARCHESANO, DOLORES R (DSW LICENSED PSYCHOL)
Entity Type:Individual
Prefix:DR
First Name:DOLORES
Middle Name:R
Last Name:MARCHESANO
Suffix:
Gender:F
Credentials:DSW LICENSED PSYCHOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 SUGARTOWN ROAD
Mailing Address - Street 2:UNIT H301
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3041
Mailing Address - Country:US
Mailing Address - Phone:610-688-6224
Mailing Address - Fax:
Practice Address - Street 1:426 PENNSYLVANIA AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3410
Practice Address - Country:US
Practice Address - Phone:610-519-0113
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008147L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
796832OtherBLUE CROSS BLUE SHIELD
0606079OtherAETNA
MA796832Medicare ID - Type Unspecified