Provider Demographics
NPI:1245353721
Name:KOLSON, PETER ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:ALAN
Last Name:KOLSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:ALAN
Other - Last Name:KOLSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:240 SHAWNEE RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1725
Mailing Address - Country:US
Mailing Address - Phone:610-649-6636
Mailing Address - Fax:610-525-4552
Practice Address - Street 1:234 S BRYN MAWR AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2133
Practice Address - Country:US
Practice Address - Phone:610-525-0390
Practice Address - Fax:610-525-4552
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004213-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist