Provider Demographics
NPI:1720378797
Name:WAXMAN, MARJORIE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:A
Last Name:WAXMAN
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 1:28 GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1400
Mailing Address - Country:US
Mailing Address - Phone:610-525-4227
Mailing Address - Fax:
Practice Address - Street 1:28 GARRETT AVE
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1400
Practice Address - Country:US
Practice Address - Phone:610-525-4227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006352-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical