Individual
MRS. JANE E IANNUZZELLI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA., MED
Contact information
Practice address
331 W STATE ST, MEDIA, PA 19063-2615
(610) 565-0515
(610) 566-4141
Mailing address
331 W STATE ST, MEDIA, PA 19063-2615
(610) 565-0515
(610) 566-4141
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS005034-L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103TC0700X
CLINICAL PSYCHOLOGY
PA
Enumeration date
01/29/2007
Last updated
04/29/2011
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