Provider Demographics
NPI:1902632011
Name:VINCENZI, HARRY (EDD)
Entity type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:VINCENZI
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:548 MONASTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-1624
Mailing Address - Country:US
Mailing Address - Phone:215-688-3691
Mailing Address - Fax:
Practice Address - Street 1:548 MONASTERY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1624
Practice Address - Country:US
Practice Address - Phone:215-688-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005211L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist