Individual
BRADLEY MARK WOLGAST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
221 N OLIVE ST, MEDIA, PA 19063-3250
(484) 442-0849
Mailing address
221 N OLIVE ST, MEDIA, PA 19063-3250
(484) 442-0849
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
B10000802
DE
103TC1900X
Counseling Psychologist
Primary
PS015452
PA
Other
Enumeration date
01/08/2022
Last updated
01/08/2022
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