Active NPI
Phyllis C Deitch, MA MFT
- Psychologist
- Bryn Mawr, PA
National Provider Identifier
1528160967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS005620L
- Practice address
- 234 Bryn Mawr Ave
Suite #202
Bryn Mawr, PA 19010 - Phone
- (610) 812-4983
- NPI assigned
- Sep 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS005620L | PA | Primary |
Addresses
Primary practice location
234 Bryn Mawr Ave
Suite #202
Bryn Mawr, PA 19010
Mailing address
58 Acadia Dr
Voorhees, NJ 08043
Phone (856) 874-1018
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DE608689 | Other | PA | BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157414400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1528160967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "58 ACADIA DR",
"city": "VOORHEES",
"state": "NJ",
"postal_code": "08043",
"telephone_number": "856-874-1018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "234 BRYN MAWR AVE",
"address_2": "SUITE #202",
"city": "BRYN MAWR",
"state": "PA",
"postal_code": "19010",
"telephone_number": "610-812-4983"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEITCH",
"first_name": "PHYLLIS",
"middle_name": "C",
"name_prefix": "Mrs.",
"credential": "MA MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS005620L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BS",
"identifier": "DE608689",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bryn Mawr, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.