MEDICARE: JOSEPH HERB M. A., TEP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS005638L	PA

General Provider Information

NPI Number	:	1225247711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSEPH HERB M. A., TEP

Provider Business Mailing Address
First Line	:	320 PLEASANT ACRE DR
Second Line	:
City	:	AMBLER
State	:	PA
Zip	:	19002-4270
Country	:	US
Telephone Number	:	215-500-1524
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 OFFICE CENTER DR
Second Line	:	SUITE 122
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3220
Country	:	US
Telephone Number	:	215-500-1524
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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