Individual
ANN MARY TOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 CHURCH ST, PHILADELPHIA, PA 19106-2201
(267) 278-1877
Mailing address
12 DOUGLAS DR, HUNTINGDON VALLEY, PA 19006-1605
(267) 278-1877
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/08/2025
Last updated
08/15/2025
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