Provider Demographics
NPI:1265525323
Name:TZOUMAS, ANTHONY C (PHD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:C
Last Name:TZOUMAS
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 1:2201 RIDGEWOOD ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-6977
Mailing Address - Country:US
Mailing Address - Phone:610-378-9601
Mailing Address - Fax:610-378-3610
Practice Address - Street 1:2201 RIDGEWOOD ROAD
Practice Address - Street 2:SUITE 400
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-6977
Practice Address - Country:US
Practice Address - Phone:610-378-9601
Practice Address - Fax:610-378-3610
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015292103G00000X, 103TC1900X, 103TC2200X, 103TM1800X
103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070681Medicare PIN
PA070681XTGMedicare PIN
PAP91739Medicare UPIN