Provider Demographics
NPI:1770646705
Name:VOGELSON, ANDREW R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:R
Last Name:VOGELSON
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 1:1601 WALNUT ST
Mailing Address - Street 2:SUITE 1128
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2944
Mailing Address - Country:US
Mailing Address - Phone:215-567-3638
Mailing Address - Fax:215-567-5572
Practice Address - Street 1:1601 WALNUT ST
Practice Address - Street 2:SUITE 1128
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2944
Practice Address - Country:US
Practice Address - Phone:215-567-3638
Practice Address - Fax:215-567-5572
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSOO2059L103T00000X
PAPS002059L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4575442OtherAETNA
PA460554000OtherMAGELLAN HEALTH SERVICES
PA0062748000OtherPERSONAL CHOICE
PA460554000OtherMAGELLAN HEALTH SERVICES