Provider Demographics
NPI:1770141996
Name:RISING SUN PSYCHOLOGICAL LLC
Entity type:Organization
Organization Name:RISING SUN PSYCHOLOGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHOREY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:610-883-7469
Mailing Address - Street 1:225 S CHESTER RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-1919
Mailing Address - Country:US
Mailing Address - Phone:610-883-7469
Mailing Address - Fax:
Practice Address - Street 1:225 S CHESTER RD STE 4
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-1919
Practice Address - Country:US
Practice Address - Phone:610-883-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS016581OtherPENNSYLVANIA PSYCHOLOGY LICENSE NUMBER
1841492667OtherSOLE PROVIDER TYPE 1 NPI