Individual
MARK JAMISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
220 E MERMAID LN, PHILADELPHIA, PA 19118-3244
(610) 733-9474
Mailing address
220 E MERMAID LN, PHILADELPHIA, PA 19118-3244
(610) 733-9474
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS0004049L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195546000
MIS NUMBER MAGELLAN
PA
Enumeration date
07/06/2006
Last updated
11/19/2007
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