Provider Demographics
NPI:1811907835
Name:NEILL, DOUGLAS (PHD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:NEILL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 EAST STATE STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1800
Mailing Address - Country:US
Mailing Address - Phone:610-444-9494
Mailing Address - Fax:610-444-9655
Practice Address - Street 1:102 EAST STATE STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:KENNET SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1800
Practice Address - Country:US
Practice Address - Phone:610-444-9494
Practice Address - Fax:610-444-9655
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA000021101YM0800X
NJ37PC00345100101YM0800X
102L00000X
PAPA000021101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health