Provider Demographics
NPI:1750468039
Name:EDELSTEIN, KAREN WESSEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:WESSEL
Last Name:EDELSTEIN
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 1:315 LAWRENCE CT
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4220
Mailing Address - Country:US
Mailing Address - Phone:215-922-1564
Mailing Address - Fax:
Practice Address - Street 1:14 ELLIOTT AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3412
Practice Address - Country:US
Practice Address - Phone:610-527-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA589412Medicare ID - Type Unspecified