Provider Demographics
NPI:1619278769
Name:COTUGNO, ERIC ANGELO (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ANGELO
Last Name:COTUGNO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S. BRYN MAWR AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010
Mailing Address - Country:US
Mailing Address - Phone:610-525-4828
Mailing Address - Fax:703-569-7248
Practice Address - Street 1:14 S. BRYN MAWR AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010
Practice Address - Country:US
Practice Address - Phone:610-525-4828
Practice Address - Fax:703-569-7248
Is Sole Proprietor?:No
Enumeration Date:2010-11-05
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004328103TC0700X
PAPS017334103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical