Provider Demographics
NPI:1689192981
Name:ZDANIS, MAUREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:ZDANIS
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 1:882 N BUCKNELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1935
Mailing Address - Country:US
Mailing Address - Phone:267-250-9814
Mailing Address - Fax:
Practice Address - Street 1:7600 STENTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3231
Practice Address - Country:US
Practice Address - Phone:267-250-9814
Practice Address - Fax:267-250-9814
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018326103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical