Individual
C FREDERICK DE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
14 FOREST RD, WAYNE, PA 19087-3204
(610) 688-0418
Mailing address
14 FOREST RD, WAYNE, PA 19087-3204
(610) 688-0418
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
PS006601L
PA
Other
Enumeration date
07/31/2006
Last updated
07/08/2007
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