Provider Demographics
NPI:1750528105
Name:MAIN LINE PSYCHOLOGICAL RESOURCES, LLC
Entity type:Organization
Organization Name:MAIN LINE PSYCHOLOGICAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:HELENE
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:484-380-2613
Mailing Address - Street 1:PO BOX 1138
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-7138
Mailing Address - Country:US
Mailing Address - Phone:484-380-2613
Mailing Address - Fax:
Practice Address - Street 1:950 E HAVERFORD RD
Practice Address - Street 2:STE 306-B
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3850
Practice Address - Country:US
Practice Address - Phone:484-380-2613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty