Provider Demographics
NPI:1740354737
Name:ESPOSITO, JOELY (PSYD)
Entity type:Individual
Prefix:
First Name:JOELY
Middle Name:
Last Name:ESPOSITO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:FURLONG
Mailing Address - State:PA
Mailing Address - Zip Code:18925-0359
Mailing Address - Country:US
Mailing Address - Phone:215-735-2505
Mailing Address - Fax:215-735-2504
Practice Address - Street 1:1528 WALNUT ST
Practice Address - Street 2:SUITE 1500
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3604
Practice Address - Country:US
Practice Address - Phone:215-735-2505
Practice Address - Fax:215-735-2504
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008878L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS008878LOtherPA STATE LICENSE NUMBER
PA054668Medicare PIN