Provider Demographics
NPI:1770677932
Name:PARKER, NINA L (PSYD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:L
Last Name:PARKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:L
Other - Last Name:PAGANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8016 HALSTEAD ST
Mailing Address - Street 2:PHILADELPHIA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2304
Mailing Address - Country:US
Mailing Address - Phone:215-779-0069
Mailing Address - Fax:
Practice Address - Street 1:8016 HALSTEAD ST
Practice Address - Street 2:PHILADELPHIA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2304
Practice Address - Country:US
Practice Address - Phone:215-779-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPSO16100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical