Provider Demographics
NPI:1154934057
Name:SORRENTINO, DALIA SIMONA (MSED)
Entity type:Individual
Prefix:
First Name:DALIA SIMONA
Middle Name:
Last Name:SORRENTINO
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2947
Mailing Address - Country:US
Mailing Address - Phone:215-932-7182
Mailing Address - Fax:
Practice Address - Street 1:288 LANCASTER AVE STE 1
Practice Address - Street 2:
Practice Address - City:FRAZER
Practice Address - State:PA
Practice Address - Zip Code:19355-1800
Practice Address - Country:US
Practice Address - Phone:610-312-8782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health