Individual
MIRIAM WONNIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M ED.,BSL
Contact information
Practice address
ONE WEST MAIN STREET, FLEETWOOD, PA 19522
(610) 944-0445
(610) 944-1196
Mailing address
69 MONTELLO RD, SINKING SPRING, PA 19608-1515
(610) 927-4249
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
BH001706
PA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
BH001706
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083756902
CONCERN PROFESSIONAL SERVICES FOR CHILDREN , YOUTH, & FAMILIES
PA
Enumeration date
11/20/2014
Last updated
11/20/2014
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