Individual provider Active NPI

Alice Trisdorfer, PH.D.

  • Clinical Psychologist
  • Philadelphia, PA
National Provider Identifier
1467575613
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PS-007723-L Issued in PA
Practice address
2130 Pine St
Philadelphia, PA 19103-6535
Phone
(610) 642-8188
Fax
(610) 645-7677
NPI assigned
Apr 10, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PS-007723-L PA Primary

Addresses

Primary practice location

2130 Pine St
Philadelphia, PA 19103-6535

Mailing address

21 Church Rd
Ardmore, PA 19003-3205
Phone (610) 642-8188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090522000086 PA Practitioner - Clinical Psychologist 7315096336 Practice locations: Ardmore, PA; Philadelphia, PA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

21 Church Rd
Ardmore, PA 19003-3205
Phone (610) 642-8188

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PS-007723-LPAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
B Janet Hibbs PHD PC Clinical PastSince Apr 28, 2005 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467575613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CHURCH RD",
            "city": "ARDMORE",
            "state": "PA",
            "postal_code": "190033205",
            "telephone_number": "610-642-8188",
            "fax_number": "610-645-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 PINE ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191036535",
            "telephone_number": "610-642-8188",
            "fax_number": "610-645-7677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRISDORFER",
        "first_name": "ALICE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS-007723-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.