Provider Demographics
NPI:1790570448
Name:PONTICELLO, ABBY JANE (MFT)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:JANE
Last Name:PONTICELLO
Suffix:
Gender:
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 GERRITT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5603
Mailing Address - Country:US
Mailing Address - Phone:732-372-8927
Mailing Address - Fax:
Practice Address - Street 1:485 DEVON PARK DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-1807
Practice Address - Country:US
Practice Address - Phone:732-372-8927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist