Individual
DR. JOSEPH P. PRIMAVERA III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1015 CHESTNUT ST, SUITE 430, PHILADELPHIA, PA 19107-4316
(215) 625-9770
(215) 625-9866
Mailing address
1015 CHESTNUT ST, SUITE 430, PHILADELPHIA, PA 19107-4316
(215) 625-9770
(215) 625-9866
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS 0047-16L
PW
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0063157000
MAGELLAN HEALTH SERVICES
PA
01
—
250823000
MAGELLAN PROVIDER MIS
PA
01
—
4404301
AETNA
PA
Enumeration date
03/09/2007
Last updated
07/09/2007
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