Provider Demographics
NPI:1871326777
Name:SHOSHANA TWERSKY PSYD LLC
Entity type:Organization
Organization Name:SHOSHANA TWERSKY PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL PSYCHOLOGIS
Authorized Official - Prefix:
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TWERSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-697-1257
Mailing Address - Street 1:2 BALA PLZ STE PL13
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1506
Mailing Address - Country:US
Mailing Address - Phone:978-697-1257
Mailing Address - Fax:610-667-2608
Practice Address - Street 1:2 BALA PLZ STE PL13
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1506
Practice Address - Country:US
Practice Address - Phone:978-697-1257
Practice Address - Fax:610-667-2608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHOSHANA TWERSKY PSYD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-26
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005878504OtherHIGHMARK BLUE SHIELD VENDOR ID