Provider Demographics
NPI:1306088968
Name:PISA, ANTHONY M (PHD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:PISA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 SWEDE RD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3375
Mailing Address - Country:US
Mailing Address - Phone:610-277-4296
Mailing Address - Fax:
Practice Address - Street 1:1717 SWEDE RD
Practice Address - Street 2:SUITE 212
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3375
Practice Address - Country:US
Practice Address - Phone:610-277-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-29
Last Update Date:2009-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002299103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic