1487962650 NPI number — MRS. PERSEFONI TILIAKOS DELAPP LPC

Table of content: MRS. PERSEFONI TILIAKOS DELAPP LPC (NPI 1487962650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487962650 NPI number — MRS. PERSEFONI TILIAKOS DELAPP LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DELAPP
Provider First Name:
PERSEFONI
Provider Middle Name:
TILIAKOS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487962650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 BUTLER PIKE
Provider Second Line Business Mailing Address:
APT. 14D
Provider Business Mailing Address City Name:
CONSHOHOCKEN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19428-1273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-909-7923
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 PLYMOUTH RD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
PLYMOUTH MEETING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19462-1656
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-825-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC005407 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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