Provider Demographics
NPI:1598334245
Name:THORNEWILL, ALICE H (PHD, JD)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:H
Last Name:THORNEWILL
Suffix:
Gender:F
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:578 WASHINGTON BLVD # 1162
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5421
Mailing Address - Country:US
Mailing Address - Phone:502-386-7517
Mailing Address - Fax:
Practice Address - Street 1:1802 GREEN ST APT 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-4017
Practice Address - Country:US
Practice Address - Phone:844-287-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSY-19249103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical