Provider Demographics
NPI:1699860254
Name:WZONTEK, NANCY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:WZONTEK
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 1:1315 WALNUT ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4717
Mailing Address - Country:US
Mailing Address - Phone:610-595-4378
Mailing Address - Fax:
Practice Address - Street 1:1315 WALNUT ST STE 1700
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4717
Practice Address - Country:US
Practice Address - Phone:610-595-4378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006188L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012030000001Medicaid
PA749192OtherBCBS
PA1012030000001Medicaid