Individual
DR. MICHAEL A DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
14 S BRYN MAWR AVE, SUITE 205, BRYN MAWR, PA 19010-3216
(610) 525-4828
Mailing address
119 KENILWORTH RD, MERION STATION, PA 19066-1309
(610) 246-2534
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS004910L
PA
103TC0700X
Clinical Psychologist
PS004910L
PA
103TC2200X
Clinical Child & Adolescent Psychologist
PS004910L
PA
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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