Provider Demographics
NPI:1760941405
Name:VAN DUSEN, JOHN P (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:VAN DUSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20134 VALLEY FORGE CIR
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1112
Mailing Address - Country:US
Mailing Address - Phone:610-878-9330
Mailing Address - Fax:267-552-1002
Practice Address - Street 1:20134 VALLEY FORGE CIR
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1112
Practice Address - Country:US
Practice Address - Phone:610-878-9330
Practice Address - Fax:267-552-1002
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018744103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist