Provider Demographics
NPI:1871708594
Name:SCHULLER, RONNA B (PHD)
Entity type:Individual
Prefix:DR
First Name:RONNA
Middle Name:B
Last Name:SCHULLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:C
Other - Last Name:SCHULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:88 MERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1630
Mailing Address - Country:US
Mailing Address - Phone:610-664-4717
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH STREET
Practice Address - Street 2:MEDICAL TOWER STE 2408
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:610-664-4717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004965L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
509574Medicare ID - Type Unspecified