Provider Demographics
NPI:1568445559
Name:NATHANSON, JUDY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:
Last Name:NATHANSON
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 1:310 LLANDRILLO RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2319
Mailing Address - Country:US
Mailing Address - Phone:610-667-3052
Mailing Address - Fax:
Practice Address - Street 1:310 LLANDRILLO RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2319
Practice Address - Country:US
Practice Address - Phone:610-667-3052
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006070L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist