Provider Demographics
NPI:1932683554
Name:SERINE, AMELIA DAWN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:DAWN
Last Name:SERINE
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 1:20 WAVERLY RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4532
Mailing Address - Country:US
Mailing Address - Phone:484-269-4089
Mailing Address - Fax:
Practice Address - Street 1:270 LANCASTER AVE BLDG J
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1858
Practice Address - Country:US
Practice Address - Phone:484-800-1488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty