Individual
GINA MARIE DATTILO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
293 HOPEWELL RD, ELVERSON, PA 19520
(540) 209-4717
Mailing address
293 HOPEWELL RD, ELVERSON, PA 19520-8804
(540) 209-4717
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS017764
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS017764
COMMONWELATH OF PENNSYLVANIA DEPARTMENT OF STATE BUREAU OF PROFESSIONAL AND OCCU
PA
Enumeration date
08/27/2008
Last updated
08/28/2018
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