Individual
MYLISSA MARY SLANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2801 GRANT AVE, PHILADELPHIA, PA 19114-1032
(215) 878-3400
Mailing address
734 CHERYL DR, WARMINSTER, PA 18974-2135
(215) 817-6849
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
—
—
103TS0200X
School Psychologist
Primary
—
—
Other
Enumeration date
07/26/2019
Last updated
01/19/2023
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