Basic Information
| Provider Information | |||||||||
| NPI: | 1568670222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POAL | ||||||||
| FirstName: | PILAR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 737 LAUREL LN | ||||||||
| Address2: | |||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190872017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109648165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 987 OLD EAGLE SCHOOL ROAD, SUITE 719 | ||||||||
| Address2: | EVOLVE CORPORATE CENTER EAST | ||||||||
| City: | WAYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109648165 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 03/27/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS005863L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 007062346-0002 | 05 | PA | MEDICAID |