Provider Demographics
NPI:1891957858
Name:WIDSETH, JANE CHRISTINA (PHD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:CHRISTINA
Last Name:WIDSETH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 S BRYN MAWR AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3216
Mailing Address - Country:US
Mailing Address - Phone:610-687-6385
Mailing Address - Fax:610-896-2969
Practice Address - Street 1:14 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3216
Practice Address - Country:US
Practice Address - Phone:610-687-6385
Practice Address - Fax:610-896-2969
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA 01909L103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling