Provider Demographics
NPI:1295890846
Name:SYWULAK & WEISS PSYCHOLOGICAL ASSOCIATES LLC
Entity type:Organization
Organization Name:SYWULAK & WEISS PSYCHOLOGICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:E
Authorized Official - Last Name:SYWULAK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:215-355-8812
Mailing Address - Street 1:928 JAYMOR ROAD
Mailing Address - Street 2:SUITE A 120
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966
Mailing Address - Country:US
Mailing Address - Phone:215-355-8812
Mailing Address - Fax:215-355-0926
Practice Address - Street 1:928 JAYMOR ROAD
Practice Address - Street 2:SUITE A 120
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966
Practice Address - Country:US
Practice Address - Phone:215-355-8812
Practice Address - Fax:215-355-0926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003501L103T00000X
NJPS005712L103TC0700X
PAPS005712L103TC0700X
PAMF000480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA670165OtherBLUE CROSS BLUE SHIELD
4664582OtherAETNA
PA428178OtherBLUE CROSS BLUE SHIELD
PA4616180OtherAETNA
4664582OtherAETNA