Provider Demographics
NPI:1386961944
Name:WAITE, GLORIA J (MA, MFT)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
Last Name:WAITE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:J
Other - Last Name:AUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:54 FRIENDS LN
Mailing Address - Street 2:SUITE 114
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3403
Mailing Address - Country:US
Mailing Address - Phone:267-566-2229
Mailing Address - Fax:215-741-0977
Practice Address - Street 1:54 FRIENDS LN
Practice Address - Street 2:SUITE 114
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3403
Practice Address - Country:US
Practice Address - Phone:267-566-2229
Practice Address - Fax:215-741-0977
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005607-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS-005607-LOtherPSYCHOLOGY LICENSE