Provider Demographics
NPI:1356389159
Name:MYERS, ELLEN P (PHD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:P
Last Name:MYERS
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 1:1445 CITY AVE
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3831
Mailing Address - Country:US
Mailing Address - Phone:610-642-5328
Mailing Address - Fax:619-649-6571
Practice Address - Street 1:1445 CITY AVE
Practice Address - Street 2:SUITE 4B
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3831
Practice Address - Country:US
Practice Address - Phone:610-642-5328
Practice Address - Fax:619-649-6571
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005847L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist