Provider Demographics
NPI:1780749424
Name:JARMAS, AUDRE L (PHD)
Entity type:Individual
Prefix:DR
First Name:AUDRE
Middle Name:L
Last Name:JARMAS
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 1:3 CYNWYD RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3306
Mailing Address - Country:US
Mailing Address - Phone:610-645-5703
Mailing Address - Fax:610-667-6214
Practice Address - Street 1:3 CYNWYD RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3306
Practice Address - Country:US
Practice Address - Phone:610-645-5703
Practice Address - Fax:610-667-6214
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005521L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA671122Medicare ID - Type Unspecified