Provider Demographics
NPI:1699889295
Name:MIHALICH, DOLORES M (PHD)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:M
Last Name:MIHALICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1243
Mailing Address - Country:US
Mailing Address - Phone:610-825-4450
Mailing Address - Fax:610-941-5532
Practice Address - Street 1:600 GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1800
Practice Address - Country:US
Practice Address - Phone:610-825-4450
Practice Address - Fax:610-941-5532
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008736L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist