Provider Demographics
NPI:1568670222
Name:POAL, PILAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:PILAR
Middle Name:
Last Name:POAL
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 1:737 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2017
Mailing Address - Country:US
Mailing Address - Phone:610-964-8165
Mailing Address - Fax:
Practice Address - Street 1:987 OLD EAGLE SCHOOL ROAD, SUITE 719
Practice Address - Street 2:EVOLVE CORPORATE CENTER EAST
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087
Practice Address - Country:US
Practice Address - Phone:610-964-8165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005863L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA007062346-0002Medicaid
PA689713Medicare PIN