| Full Spectrum Llc | |
|
925 Roscommon Rd Bryn Mawr PA 19010-1842 | |
| (215) 313-0057 | |
| Not Available |
| Full Name | Full Spectrum Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 925 Roscommon Rd, Bryn Mawr, Pennsylvania |
| Authorized Official Name and Position | Marcy A Shoemaker (OWNER) |
| Authorized Official Contact | 2153130057 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Full Spectrum Llc 2 Bala Plz Suite 3 Bala Cynwyd PA 19004-1501 Ph: (215) 313-0057 | Full Spectrum Llc 925 Roscommon Rd Bryn Mawr PA 19010-1842 Ph: (215) 313-0057 |
| NPI Number | 1538496138 |
|---|---|
| Provider Enumeration Date | 11/03/2009 |
| Last Update Date | 01/13/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538496138 | NPI | - | NPPES |
| PTAN 039191 | Other | PA | MEDICARE PTAN: 039191 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | PS016629 (Pennsylvania) | Primary |
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