Individual
EDNA B FOA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3535 MARKET ST., 3RD FLOOR, PHILADELPHIA, PA 19104-3309
(215) 746-6700
(215) 746-5155
Mailing address
3535 MARKET ST., 3RD FLOOR, PHILADELPHIA, PA 19104-3309
(215) 746-6700
(215) 746-5155
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS000469L
PA
Other
Enumeration date
07/04/2006
Last updated
04/19/2012
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