Provider Demographics
NPI:1598241465
Name:MICHELSON, SANDRA TESTA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:TESTA
Last Name:MICHELSON
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 1:314 MOORE BLDG
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16802-3103
Mailing Address - Country:US
Mailing Address - Phone:814-865-2191
Mailing Address - Fax:814-863-1331
Practice Address - Street 1:314 MOORE BLDG
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16802-3103
Practice Address - Country:US
Practice Address - Phone:814-865-2191
Practice Address - Fax:814-863-1331
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018426103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical