Individual
GWEN MOCKLER WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4617 WOODLAND AVE FL 1, PHILADELPHIA, PA 19143-3836
(267) 254-0015
Mailing address
4617 WOODLAND AVE FL 1, PHILADELPHIA, PA 19143-3836
(267) 254-0015
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS016295
PA
Other
Enumeration date
11/19/2018
Last updated
11/19/2018
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