Individual
DR. JEANINE MARIE VIVONA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
11 BALA AVE, BALA CYNWYD, PA 19004-3201
(215) 570-4947
Mailing address
215 PELHAM RD, PHILADELPHIA, PA 19119-2624
(215) 843-7368
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS-008618-L
PA
Other
Enumeration date
06/06/2007
Last updated
07/08/2007
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