Individual
MRS. PHYLLIS C DEITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA MFT
Contact information
Practice address
234 BRYN MAWR AVE, SUITE #202, BRYN MAWR, PA 19010
(610) 812-4983
Mailing address
58 ACADIA DR, VOORHEES, NJ 08043
(856) 874-1018
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS005620L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE608689
BS
PA
Enumeration date
09/05/2006
Last updated
07/08/2007
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