Provider Demographics
NPI:1912026717
Name:D. WAYNE POPPALARDO, LLC
Entity type:Organization
Organization Name:D. WAYNE POPPALARDO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POPPALARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:856-428-6644
Mailing Address - Street 1:118 N HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2306
Mailing Address - Country:US
Mailing Address - Phone:856-428-6644
Mailing Address - Fax:
Practice Address - Street 1:135 S 19TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-4912
Practice Address - Country:US
Practice Address - Phone:215-561-4466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003474L103T00000X
NJ00951101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty